MDwise
Rights and Responsibilities

Rights and Responsibilities

MDwise provides access to medical care for all its members. We do not discriminate based on your religion, race, national origin, color, ancestry, handicap, sex, sexual preference or age.

Medical care is based on scientific principles. We provide care through a partnership that includes your doctor, MDwise, other health care staff and you – our member.

MDwise has rules about who can see and use private data about you. This includes your race/ethnicity and language you speak. We collect this to help with your care and improve your health. We will not use this information to make decisions about your coverage benefits.

MDwise is committed to partnering with you and your doctor. We will:

• Treat you and your family with dignity and respect.
• Maintain your personal privacy.
• Keep your medical records confidential as required by law.
Give you a clear explanation of your medical condition. You have a right to be part of all your treatment decisions. If you understand the options, you can better decide if you want a certain treatment. Options will be discussed with you no matter what they cost or whether they are covered as a benefit.
• Provide you with information about MDwise, its services, its doctors and your rights and responsibilities.

In addition, YOU have the right to:

• Change your doctor by calling the MDwise customer service department.
• Appeal any decisions we make about your health care. You can make a complaint about personal treatment.
• Get copies of your medical records or limit access to these records, according to state and federal law.
• Amend your medical records that we keep.
• Get information about your doctor.
• Request information about the MDwise organization and operations.
• Refuse care from any doctor.
• Ask for a second opinion.
• Make complaints about MDwise, its services, doctors and policies.
• Get timely answers to your complaints or appeals.
• Take part in member satisfaction surveys.
• Prepare an advance directive, as MDwise provides information to members about advance directives in accordance with applicable state laws.
• Get help from the Indiana Family and Social Services Administration (FSSA) about covered services, benefits or complaints.
• Get complete benefit information. This includes how to get services during regular hours, emergency care, after-hours care, out-of-area care, exclusions and limits on covered services. Request information about our physician incentive plan.
• Be told about changes to your benefits and doctors.
• Be told how to choose a different health plan.
• Health care that makes you comfortable based on your culture.
• Choose to opt out of managed care if you are a Native American or Alaskan Native.
• Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation, in accordance with Federal regulations. This means that your doctor cannot restrain or seclude you because it is the easiest thing to do. The doctor cannot make you do something that you do not want to do. The doctor cannot try to get back at you for something that you may have done.
• When you exercise these rights, you will not be treated differently.
• Provide input on MDwise member rights and responsibilities.
• Participate in all treatment decisions that affect your care.
• If MDwise closes or becomes insolvent, you are not responsible for our debts. Also, you would not be responsible for services that were given to you because the State does not pay MDwise, or that MDwise does not pay under a contract. Finally, in the case of insolvency, you do not have to pay any more for covered services than what you would pay if MDwise provided you with the services directly.

YOU are responsible for:

• Contacting your doctor for all your medical care.
• Treating the doctor and their staff with dignity and respect.
• Understanding your health problems to the best of your ability and working with your doctor to develop treatment goals that you can both agree on.
• Telling your doctor everything you know about your condition and any recent changes in your health.
• Telling your doctor if you do not understand your care plan or what is expected of you.
• Following the plans and instructions for care that you have agreed upon with your doctor.
• Keeping scheduled appointments.
• Notifying your doctor 24 hours in advance if you need to cancel an appointment.
• Telling us about other health insurance that you have.

IMPORTANT TIP:

If you do not follow your doctor’s advice, this may keep you from getting well. It is your job to talk with your doctor if you have any questions about your medical care. Don’t ever be afraid to ask your doctor questions. It is your right.