Member Rights & Responsibilities

Member’s Rights and Responsibilities

McLaren Health Plan Members have the right to:

  • Confidentiality
  • Be treated with respect and recognition of their dignity and the right to privacy, including to be free from restraint and seclusion
  • Have access to a primary care provider or provider designee 24 hours a day, 365 days a year for urgent care
  • Receive culturally and linguistically appropriate services
  • The right to receive covered benefits consistent with your contract and State and Federal regulations
  • Obtain a current provider directory of participating providers and access to a choice of specialists within the network who are experienced in treatment of chronic disabilities, with a referral
  • Obtain OB-GYN and pediatric services from network providers without a referral request
  • Continue receiving services from a provider who has been terminated from the Plan’s network, through the episode of care, as long as it remains medically necessary to continue treatment with this provider, including female members who are pregnant have the right to continue coverage from a terminated provider that extends to the postpartum evaluation of the member, up to 6 weeks after delivery
  • Have no "gag rules" from the Plan. Doctors are free to discuss all medical treatment options, even if they are not covered services
  • Participate in decision-making regarding his/her health care, including the right to refuse treatment, to obtain a second opinion, and express preferences about treatment options
  • Receive a copy of their medical record upon request, and request those to be amended or corrected
  • Know how the Plan pays its doctors, allowing Members to know if there are financial incentives or disincentives tied to medical decisions; and the right to be provided with a telephone number and address to obtain additional information about compensation methods, if desired
  • Voice complaints or appeals about McLaren Health Plan, the care provided or a decision to deny or limit coverage, including that a member or provider cannot be penalized for filing a complaint or appeal in compliance with federal and state laws
  • Receive information about McLaren Health Plan, including the services provided, the practitioners and providers, and the members’ rights and responsibilities
  • Make recommendations regarding McLaren Health Plan’s member’s rights and responsibilities
  • Be free from other discrimination prohibited by State and Federal regulations
  • Having the member’s medical record be kept confidential by McLaren Health Plan and the PCP

McLaren Health Plan Members have the responsibility to:

  • Schedule appointments in advance and be on time; and cancel an appointment with the doctor’s office as soon as possible
  • Use the hospital emergency room only for acute or emergency care, not for routine care - this means following the protocol and using the emergency room only when medically necessary, and contacting the PCP prior to a visit to the emergency room
  • Become a partner with the PCP in planning individual health care and completing treatments, including supplying the information (to the extent possible), to practitioners, providers, and the health plan that is needed to deliver the services needed
  • Follow plans and instructions for care that the member has agreed on with all their treating health care providers and practitioners
  • Understanding their health problems and participate in developing treatment goals to the degree possible
  • Notify McLaren Health Plan’s Customer Service immediately for any change in address or telephone number
  • Allow McLaren Health Plan to assist with health care and services to which a member is entitled and of notifying the Plan of any problem related to health care, benefits, etc.
  • Forward suggestions to McLaren Health Plan in writing or contacting Customer Service for assistance
  • Carry the McLaren Health Plan Member ID card at all times

(January 2016)