Member Rights & Responsibilities
Your “rights” are the things you can count on getting from us. Your “responsibilities” are the things we need from you. As a person with IHN-CCO coverage, you have many rights and responsibilities.
What you can count on from us
As a member of InterCommunity Health Network CCO (IHN-CCO) and Oregon Health Plan (OHP), you have many rights. These include choosing your own provider and making a complaint to us. Here is a full list of what you can count on from IHN-CCO:
- Be treated with dignity and respect.
- Be treated by your doctors the same as they treat all their patients.
- Get handbooks and letters that you can understand.
- Get services and support that fit your culture and language needs.
- Have the same access to care as all members, no matter your age or sex.
- Complain or appeal and get a response from us without a bad reaction from your plan or provider.
- Be free from getting restrained or confined unless allowable or needed.
- Get a copy of our nondiscrimination policy.
- Choose an in-network PCP when you first enroll and change your PCP at other times.
- Get mental health and family planning services without a referral.
- Ask for services as close to home as possible, and in a non-traditional setting that is easier for you to use.
- Get a sexual abuse exam, if needed, without prior approval.
- Get care when you need it, any time of day or night (including weekends and holidays) with no prior approval required.
- See a specialist without a referral.
- Actively help develop your treatment plan or have family involved in your treatment plan.
- Get information about OHP-covered and non-covered treatment options for your condition.
- Agree to or refuse treatment (except for court-ordered services) and be told how that will affect you.
- Get the tests you need to find out what condition you have.
- Get coordinated care and services that are specific to your needs and are medically needed.
- Have steady and stable contact with a care team that is in charge of your complete care management.
- Get covered services that help you stay healthy.
- Have a medical chart kept up to date by your doctor.
- See and get a copy of your medical chart, unless there is a legal reason that does not allow it. You may ask to change or correct what is in your chart.
- Have your medical chart sent to another doctor.
- Have an Advance Directive or Power of Attorney and have your doctors follow it.
- Get a letter if you are denied a service or there is a change in service. You may not get a letter if the law does not require it.
- Be told ahead of time if your appointment is not going to happen.
- Get covered services without owing copays.
- Get a second opinion at no cost. We can help you find a second doctor to see.
- Get your doctor's opinion on treatment available to you.
- Have a friend, family member, or helper come to your appointments.
- Have a helper that will coordinate your care in the best location for you.
- Ask us how to connect to people who can support your overall health and wellbeing.
- Ask for a hearing with the state if you do not agree with our appeal answer.
- Ask for an interpreter approved by the state.
What we need from you
Being an IHN-CCO member also means you have responsibilities to us. To help us serve you best, you agree to the following:
- Find a doctor or other provider you can work with and tell them about your health.
- Treat providers and their staff with the same respect you want.
- Be on time for appointments.
- Call your provider at least one day before your appointment, if you cannot make it.
- Have yearly check-ups, wellness visits and other services to prevent illness and keep you healthy.
- Go to your PCP for all your healthcare needs, unless it is an emergency.
- Contact your doctor before going to urgent care or the emergency room, unless your condition is life threatening.
- Be honest with your doctor so your medical record is correct.
- Help your doctor get medical records from other doctors. You may need to sign a paper to give approval.
- Ask questions when you do not understand.
- Use your medical care team resources to make informed choices about your care.
- Help your doctor create a care plan.
- Follow the treatment plan you agreed to with your medical care team.
- Tell your provider you have IHN-CCO and show them your ID card if they ask for it.
- Call OHP Client Services at 800-699-9075 when you or a family member move in or out of your house or you change your phone number. Also, tell them when you become pregnant, are no longer pregnant, or have a baby.
- Call OHP Client Services at 800-699-9075 to report any other health insurance. You can also report other health insurance at www.ReportTPL.org.
- Pay for services you agree to get that are not covered by IHN-CCO.
- Provide IHN-CCO facts about other sources who are paying for your care. Pay back IHN-CCO for any bills we paid if you get a medical settlement.
- Tell IHN-CCO if you have a complaint or grievance.