Rights & Responsibilities

Your Membership Rights

As a member of CareSource you have the following rights:

  • To receive information about CareSource, our services, our practitioners and 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.
  • 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 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 care treatment, given in a way that you can follow.
  • To be sure that 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, 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 CareSource has to by law.
  • To be able to say “no” to treatment or therapy. If you say no, the doctor or CareSource 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 Navigate Member Handbook for information.
  • A right 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 you;
    • in the prevalent non-English languages of members in CareSource’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 CareSource 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). See Navigate Member Handbook which explains about advance directives. You can also contact Member Services for more information.
  • To file any complaint about not following your advance directive with the Ohio Department of Health.
  • To change your Primary Care Provider (PCP) to another PCP in the CareSource network at least monthly. CareSource must send you something in writing that says who the new PCP is and the date the change began.
  • To be free to carry out your rights and know that CareSource, CareSource’s providers or the Ohio Department of Medicaid (ODM) 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 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 on in the CareSource network for covered woman’s health services.
  • To be able to get a second opinion from a qualified provider on in the CareSource network. If a qualified provider is not able to see you, CareSource must set up a visit with a provider not in the network.
  • If CareSource is unable to provide a necessary and covered service in our network, CareSource 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 from us.
  • To make recommendations regarding CareSource’s member rights and responsibility policy.
  • To contact the United States Department of Health and Human Services Office of Civil Rights and/or the Ohio Department of Medicaid  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, veteran’s status, ancestry, health status or need for health services.

Office for Civil Rights

United States Department of Health and Human Services
233 N. Michigan Ave. – Suite 240
Chicago, Illinois 60601
312-886-2359 (TTY: 312-353-5693)

Bureau of Civil Rights
Ohio Department of Medicaid
30 E. Broad St., 30th Floor
Columbus, Ohio 43215
1-866-227-6353 (TTY: 1-866-221-6700)
Fax: 614-752-6381

CareSource may not discriminate on the basis of race, color, religion, gender, sexual orientation, age, disability, national origin, veteran’s status, ancestry, health status, or need for health services in the receipt of health services.

Member Responsibilities

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

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

Member Services: 1-800-488-0134 (TTY: 1-800-750-0750 or 711), Monday – Friday 7 a.m. – 8 p.m.