Rights & Responsibilities

Member Rights

CareSource members have the following rights:

  • To get information about CareSource, its services, its providers, and member rights and duties.
  • To get all services that CareSource must provide.
  • To be treated with respect and with regard for the member’s dignity and privacy.
  • To be sure their personal information and medical records will be kept private.
  • To be given information about their health. This information may also be available to someone legally authorized to have the information. It may also be given to someone the member has said should be reached in an emergency when it is not in the best interest of the member’s health for the member to receive it.
  • To discuss information on any appropriate or medically necessary treatment options and alternatives for their condition, regardless of cost or benefit coverage, in a manner appropriate to their condition and their ability to understand.
  • To be able to participate with providers in making decisions about their health care including the right to refuse treatment.
  • To get information about any medical care, given in a way that they can understand.
  • To be sure that others cannot hear or see them while they are getting medical care.
  • Be free from any form of restraint or seclusion as a means of coercion, discipline, convenience or retaliation, as specified in federal regulations on the use of restraints and seclusion.
  • To ask for and receive a copy of their medical records and to be able to ask that the record be changed/corrected if needed in accordance with federal privacy law.
  • The right to request at any time, information on our physician incentive plan, marketing materials or information about the structure and operation of CareSource.
  • To be able to say yes or no to having any information about them given out unless CareSource has to by law.
  • To be able to say no to treatment or therapy. If they or their parent/guardian say no, the doctor or CareSource must talk to them about what could happen and a note must be placed in their medical record about refusing care.
  • To freely be able to file an appeal, a grievance (complaint), or request a state fair hearing and that the exercise of these rights will not adversely affect the way they are treated.
  • To be able to get all written member information from CareSource:
    • At no cost to them.
    • In the prevalent non-English languages of members in CareSource’s service area.
    • In other formats, to help with special needs if they have trouble reading the information for any reason.
  • To be able to get help free of charge from CareSource and its providers if they do not speak English or need help in understanding information.
  • To be able to get help with sign language if they are hearing impaired.
  • To be told if the health care provider is a student and to be able to refuse his/her care.
  • To get information on treatment options in a way they or their parent/guardian can understand.
  • To make Advance Directives.
  • To be free to carry out their rights and know that CareSource, our providers or the Indiana Office of Medicaid Policy and Planning will not hold this against them.
  • To know that CareSource must follow all federal and state laws, and other laws about privacy that apply.
  • To choose the provider that gives them care whenever possible and appropriate.
  • Female members have the right to see a women’s health provider for covered women’s health services.
  • To be able to get a second opinion from a qualified network provider. If a qualified provider is not available, CareSource must set up a visit with a provider not on its panel.
  • To go out of network for care if CareSource is unable to provide a covered service in our network.
  • To get information about CareSource from CareSource.
  • To make suggestions about CareSource’s member rights and responsibility policy.
  • To only be responsible for cost sharing in accordance with federal and state regulations and contracts.
  • To not be held liable for CareSource’s debts in the event of insolvency.
  • To not be held liable for covered services provided to them for which DCH or CareSource does not pay the health care provider that furnishes the services.
  • To not be held liable for payments of covered services furnished under a contract, referral, or other arrangement to the extent that those payments are in excess of the amount they would owe if CareSource provided the services directly.

 Member Responsibilities

  • Use only approved providers.
  • Keep doctor appointments; be on time, and call 24 hours before the scheduled appointment to cancel.
  • Follow the advice and instructions (steps) for care they have agreed to with their doctors and other health care providers.
  • Always carry their ID card. Show it when getting care.
  • Never let anyone else use their ID card.
  • Tell their county caseworker and CareSource of a change in phone number or address.
  • Contact their PMP after going to an urgent care center or after getting physical or behavioral health care.
  • Let CareSource and the county caseworker know if they have other health insurance coverage.
  • Provide the information that CareSource and their health care providers need, to the extent possible, in order to provide care.
  • Tell us of suspected fraud as described in the Fraud, Waste and Abuse section of this handbook.
  • Understand as much as possible about their health issues and take part in reaching goals agreed to with their health care provider.