Rights & Responsibilities

Member Rights

CareSource members have these rights:

  • To receive information about CareSource, its services, its practitioners and health care providers, and member rights and responsibilities
  • To receive all services that CareSource must provide
  • To be treated with respect and with regard for your dignity and privacy
  • A right to a candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage
  • 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 authorized to get information on your health. This person could be reached in an emergency if you are unable to receive the information on your own
  • To request information at any time on our physician incentive plan or marketing materials
  • To be able to take part in decisions about your health care unless it is not in your best interest
  • To get information about any medical care treatment in a way that you can understand
  • To get care that is culturally sensitive and respectful
  • To be sure that others cannot hear or see you when 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 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 yourself given out unless CareSource has to by law
  • To be able to say no to treatment or therapy. If you say no, the health care provider or CareSource must talk to you about what could happen, and a note must be placed in your medical record about the treatment refusal
  • To be able to file an appeal, a grievance (complaint) or State Fair Hearing
  • To voice complaints or appeals about the organization or the care it provides
  • To be able to get all CareSource written member information from CareSource:
    • At no cost to the member in the prevalent non-English languages of members in CareSource’s service area
    • For members with special needs with reading the information for any reason
  • To be able to get help free of charge from CareSource and its health care providers if the member does not speak English or needs help understanding the information
  • To be able to get help with sign language if the member is 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 an advance directive (a living will)
  • To file a complaint with the Indiana Office of Medicaid Policy and Planning (OMPP) about not following the member’s advance directive
  • To be free to carry out your rights and know that CareSource, CareSource providers, or the Indiana Office of Medicaid Policy and Planning (OMPP) will not hold this against you
  • To know that CareSource must follow all federal and state laws, and other laws about privacy that apply, to choose the health care provider that gives you care whenever possible and appropriate
  • If you are a female member, you have the right to see a CareSource provider specializing in women’s health
  • To be able to get a second opinion from a qualified provider on CareSource’s panel, and if a qualified provider is not able to see the member, CareSource must set up a visit with a provider not on its panel
  • To go out of network for care provided out of cost if CareSource is unable to provide a covered service within 60 miles of your home in our network
  • To get information about CareSource’s structure and operation
  • To make recommendations regarding CareSource’s member rights and responsibility policy

 Member Responsibilities

As a CareSource member you have these responsibilities:

  • Use only approved health care providers.
  • Keep scheduled health care provider appointments. Be on time and call 24 hours in advance of a cancellation.
  • Follow the advice and instructions for care you have agreed upon with your doctors and other health care providers.
  • Always carry your ID card and present it when receiving services.
  • Never let anyone else use your ID card.
  • Alert CareSource of any suspected fraud or abuse per the instructions in this handbook.
  • Notify your county caseworker and CareSource of a change in phone number or address.
  • Contact your PMP after going to an urgent care center or after getting physical or mental health and addiction services care outside of CareSource’s covered counties or service area.
  • Let CareSource and the county caseworker know if you have other health insurance coverage.
  • Provide the information that CareSource and your health care providers need, to the extent possible, in order to provide care.
  • Understand as much as possible about your health issues and take part in reaching goals that you and your health care provider agree upon.