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Member Rights and Responsibilities

As a member of WellCare of North Carolina, you have certain rights and responsibilities. WellCare of North Carolina will respect your rights. We make sure that no one working for our plan, or any of our providers, will prevent you from using your rights. Also, we will make sure that you are aware of your responsibilities as a member of our plan.

Your Rights

As a member of WellCare of North Carolina, you have a right to:

  • Receive information about WellCare of North Carolina, its services, its practitioners and providers, and member rights and responsibilities
  • Be cared for with respect, without regard for health status, sex, race, color, religion, national origin, age, marital status, sexual orientation or gender identity
  • Be told where, when and how to get the services you need from WellCare of North Carolina
  • Be told by your Primary Care Physician (PCP) what health issues you may have, what can be done for you and what will likely be the result, in language you understand
  • An open discussion of treatment options for your conditions, regardless of cost or benefit coverage
  • Get a second opinion about your care
  • Give your approval of any treatment
  • Give your approval of any plan for your care after that plan has been fully explained to you
  • Refuse care and be told what you may risk if you do
  • Get a copy of your medical record and talk about it with your PCP
  • Ask, if needed, that your medical record be amended or corrected
  • Be sure that your medical record is private and will not be shared with anyone except as required by law, contract or with your approval
  • Use the WellCare of North Carolina complaint process to settle complaints. You can also contact the NC Medicaid Ombudsman any time you feel you were not fairly treated (see page 66 for more information about the Ombudsman Program).
  • Use the State Fair Hearing system
  • Appoint someone you trust (relative, friend or lawyer) to speak for you if you are unable to speak for yourself about your care and treatment
  • Make recommendations about WellCare of North Carolina’s member rights and responsibilities policy
  • Receive considerate and respectful care in a clean and safe environment free of unnecessary restraints
  • File a complaint with the Department if they are not satisfied with their grievance resolution
  • Be informed of the availability of Medicaid transportation services at no cost
  • Have the transportation policy explained, including how to request or cancel a trip, limitations on transportation, personal conduct, and no-shows
  • Be transported to medical appointments if unable to arrange or pay for transportation
    • By means appropriate to circumstances
    • To arrive at the medical provider in time for their scheduled appointment
    • Be informed that a Member under the age of eighteen (18) does not have to ride alone and that member and/or attendants can ride at no additional cost
    • Request a hearing if the request for transportation assistance is denied
    • WellCare of North Carolina will also make sure that costs for covered benefits and services are not avoided by us by referring you to publicly supported health care resources

We are committed to keeping your race, ethnicity, and language (REL), and sexual orientation and gender identity (SOGI) information confidential. We use some of the following methods to protect your information:

  • Maintaining paper documents in locked file cabinets
  • Requiring that all electronic information remain on physically secure media
  • Maintaining your electronic information in password-protected files

We may use or disclose your REL and SOGI information to perform our operations. These activities may include:

  • Designing intervention programs
  • Designing and directing outreach materials
  • Informing health care practitioners and providers about your language needs
  • Assessing health care disparities

We will never use your REL and SOGI information for underwriting, rate setting or benefit determinations or disclose your REL or SOGI information to unauthorized individuals.

Your Responsibilities

As a member of WellCare of North Carolina, you agree to:

  • Work with your PCP to protect and improve your health
  • Supply information (to the extent possible) that WellCare of North Carolina and its practitioners and providers need in order to provide care
  • Find out how your health plan coverage works
  • Listen to your PCP’s advice and ask questions
  • Follow plans and instructions for care that you have agreed to with your practitioners
  • Call or go back to your PCP if you do not get better or ask for a second opinion
  • Treat health care staff with respect
  • Understand your health problems and work to create a care plan in which both you and your doctor agree
  • Tell us if you have problems with any health care staff by calling Member Services at 1-866-799-5318
  • Keep your appointments. If you must cancel, call as soon as you can.
  • Use the Emergency Department only for emergencies
  • Call your PCP when you need medical care, even if it is after hours
  • Use transportation resources which are available and appropriate to their needs in the most efficient and effective manner
  • Use transportation services, such as gas vouchers, appropriately
  • Travel to the requested location and receive a Medicaid covered service
  • Make timely requests for transportation assistance
  • Be ready and at the designated place and time for transportation pick
  • Cancel transportation services that are no longer needed
  • Follow the instructions of the driver
  • Respect and do not violate the rights of other passengers or the driver by not creating a disturbance or engaging in threatening language or behavior