Rights and responsibilities of a Molina Healthcare (Molina) Member
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- Be treated carefully, with respect and privacy for his or her dignity and privacy.
- Be treated fairly, whatever your:
- Race.
- Religion.
- National origin.
- Gender.
- Age.
- Ethnic background.
- Disability.
- Behavioral health condition (intellectual).
- Sexual preference.
- Genetic information.
- Source or ability of payment.
- Have your treatment and other information kept private. We share treatment records without your okay only when the law allows it.
- Get care easily and when you need it.
- Be able to get an emergency/replacement caregiver for critical services within two hours.
- Learn about treatment options and in a way that:
- Respects your culture.
- You can understand.
- Fits your needs.
- Take part in making your plan of care.
- Get information in a language you can understand. Know about providers who speak languages other than English. And get things translated at no cost.
- Get information in other ways if you ask for it.
- Get information about Molina and its:
- Providers.
- Programs.
- Services.
- Role in the treatment process.
- Get information about clinical rules followed in your care.
- Ask your providers about their work history and training.
- Not be kept alone or forced to do something you do not want to do. This is based on a federal law.
- Give your thoughts on the Rights and Responsibilities policy.
- Ask for a certain type of provider.
- Have your provider make care decisions based on the treatment you need.
- Get health care services that obey state and federal laws about your rights.
- Help make decisions about your health care. This includes the right:
- To get a second medical opinion from a qualified health care provider within the network or have a second opinion arranged outside the network at no cost to you.
- To say no to treatment. This is your right unless the court says otherwise.
- File a complaint or grievance about:
- Molina.
- A provider.
- The care you receive.
- File an appeal about a Molina action or decision. You can ask for a State Fair Hearing if you are not happy with the result of the appeal.
- Sign a form saying that you know your health information may be shared in a public way during the State Fair Hearing process. this applies if your provider asks for a State Fair Hearing for you. Your provider will need you to sign this form.
- Request and receive a copy of your medical records at no cost once year:
- If there are any changes needed to your medical records, you may request these be changed and/or amended at any time.
- We will respond to the request within 30 days with either delivery of the medical records or a written denial that includes why the request was denied. If you receive a denial, you will get information about how to seek review of the decision.
- Use your rights. This will not affect the way Molina and its providers treat you.
- Get written information on advance directives and your rights under state law. We can get you information on how to create your own advance directive. (An advance directive tells doctors the kind of care you would want if you become too sick to decide.)
- Talk with your provider about the types of treatment that are right for you. The cost or benefit coverage do not affect this.
- Get information about how and where to access benefits from the state that are not covered under your plan. This could include cost-sharing. It could also include transportation.
- Ask for information in a way that you can get to it easily. This applies if you have a visual, hearing or physical disability. This will help you know what benefits and services you have access to.
- Receive information about Molina Healthcare, its services, its practitioners and providers and member rights and responsibilities.
- Be free from any form of restraint or seclusion as a means of coercion, discipline, convenience or retaliation.
- Receive treatment for any emergency medical condition at any hospital or other setting that may lead to more harm if you don’t get treatment right away.
- Request information about a doctor’s contract status, including physician incentive plans or other compensation arrangements, use of referral services, member survey results and whether stop-loss insurance is required. To get this information, please call Member Services at (800) 424-5891 (TTY/TDD: 711).
- Exercise his or her rights and that the exercise of those rights shall note adversely affect service delivery to the member 42 CFR 438.100(c).
- Get treatment you need from a provider.
- Treat with respect anyone giving you care.
- Give providers and Molina the information they need. This helps providers give you quality care. It helps us give you the right service.
- Ask questions about your care. This helps you and your providers understand your health problems. It helps create treatment goals and plans you agree on.
- Follow your treatment plan. You and your provider should agree on this plan.
- Follow the plan for taking your medicine. You and your provider should agree on the plan.
- Tell your providers and PCP about changes in your medicine. This includes medicines other doctors give you.
- Come to all your provider visits. Call your provider as soon as you know you need to cancel a visit.
- Tell your provider when you think the treatment plan isn’t working.
- Tell your provider if you have problems playing copays.
- Share your worries about the quality of your care.
- Tell someone if you suspect abuse and fraud (this is someone not being honest).
- Call the Molina Healthcare AlertLine. You can reach this number 24 hours a day and 7 days a week.
- You don’t have to give your name when you call.
- All calls will be looked into and will stay private.
- You can report fraud, waste and abuse:
- – By calling the AlertLine: 1-866-606-3889
- – Online:
- You may also report fraud, waste and abuse to the state or federal government.
AHCCCS Performance Measure Results
AHCCCS collects, monitors, and evaluates data representative of Contractor, Line of Business, Agency, and system-level performance. The information is available to you here: https://www.azahcccs.gov/Resources/OversightOfHealthPlans/quality.html