Rights & Responsibilities

Member Rights

As a member of our health plan, you have the following rights:

  • To receive information about CareSource MyCare Ohio, our services, our practitioners and providers and member rights and responsibilities.
  • To receive all services that our plan must provide.
  • To be treated with respect and with regard for your dignity and privacy.
  • To be sure that your medical record information will be kept private.
  • To be given information about your health. This information may also be available to someone who you have legally approved to have the information or who you have said should be reached in an emergency when it is not in the best interest of your health to give it to you.
  • To discuss information on any appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage.
  • To be able to take part in decisions about your health care unless it is not in your best interest.
  • To get information on any medical or behavioral health care treatment, given in a way that you can follow.
  • To be sure others cannot hear or see you when you are getting medical care.
  • To be free from any form of restraint or seclusion used as a means of force, discipline, ease, or revenge as specified in federal regulations.
  • To ask for, and get, a copy of your medical records, and to be able to ask that the record be changed/corrected if needed.
  • To be able to say yes or no to having any information about you given out unless we have to by law.
  • To be able to say no to treatment or therapy. If you say no, the doctor or our plan must talk to you about what could happen and they must put a note in your medical record about it.
  • To be able to file an appeal, a grievance (complaint) or state hearing. See your member handbook for information.
  • To be able to get all CareSource MyCare Ohio written member information from our plan:
    • At no cost to you.
    • In the prevalent non-English languages of members in CareSource MyCare Ohio’s service area.
    • In other ways, to help with the special needs of members who may have trouble reading the information for any reason.
  • To be able to get help free of charge from our plan and its providers if you do not speak English or need help in understanding information.
  • To be able to get help with sign language if you are hearing impaired.
  • To be told if the health care provider is a student and to be able to refuse his/her care.
  • To be told of any experimental care and to be able to refuse to be part of the care.
  • To make advance directives (a living will).
  • To file any complaint about not following your advance directive with the Ohio Department of Health.
  • To be free to carry out your rights and know that CareSource MyCare Ohio, CareSource MyCare Ohio’s providers or the Ohio Department of Medicaid (ODM) will not hold this against you.
  • To know that we must follow all federal and state laws, and other laws about privacy that apply.
  • To choose the provider that gives you care whenever possible and appropriate.
  • If you are a female, to be able to go to a woman’s health provider in our network for Medicaid-covered woman’s health services.
  • To be able to get a second opinion for Medicaid-covered services from a qualified provider in our network. If a qualified provider is not able to see you, we must set up a visit with a provider not in our network.
  • If CareSource MyCare Ohio is unable to provide a necessary and covered service in our network, we will cover these services out of network for as long as we are unable to provide the service in network. If you are approved to go out of network, this is your right as a member and will be provided at no cost to you.
  • To get information about CareSource MyCare Ohio from us.
  • To make recommendations regarding CareSource MyCare Ohio’s member rights and responsibility policy.
  • To make recommendations regarding a change in CareSource staff.
  • To contact the United States Department of Health and Human Services Office of Civil Rights and/or the Ohio Department of Job and Family Services’ Bureau of Civil Rights at the addresses below with any complaint of discrimination based on race, color, religion, gender, sexual orientation, age, disability, national origin, military status, genetic information, ancestry, health status or need for health services.  

Member Responsibilities

As a member of CareSource MyCare Ohio you must also be sure to:

  • Have an in-network primary care provider (PCP).
  • Use only approved primary care providers (PCPs).
  • Keep scheduled doctor (specialist) appointments, be on time, and if you have to cancel, call 24 hours in advance.
  • Follow the plans and instructions for care you have agreed upon with your doctors and other health care providers.
  • Always carry your CareSource member ID card and present it when receiving services.
  • Never let anyone else use your CareSource member ID card.
  • Notify your county caseworker and CareSource MyCare Ohio of a change in your phone number or address.
  • Contact your primary care provider (PCP) after going to an urgent care center or after getting medical care outside of CareSource MyCare Ohio’s covered counties or service area.
  • Let CareSource MyCare Ohio and your county caseworker know if any member of your family has other health insurance coverage.
  • Provide the information that CareSource MyCare Ohio and your health care providers need in order to provide care for you.
  • Understand as much as possible about your health conditions and take part in reaching goals that you and your PCP agree upon.
  • Let us know if you suspect health care fraud or abuse.