Rights and Responsibilities

Member Rights

As a Neighborhood member, you have the following rights: 

  • To receive information about Neighborhood, its services, practitioners, and providers, and members’ rights and responsibilities. 
  • To be treated with respect and recognition of your dignity and right to privacy. 
  • To participate with your practitioners in decision-making about your health care. 
  • To privacy of all records and communications as required by law. (Neighborhood employees follow a strict confidentiality policy regarding all member information.) 
  • To be treated respectfully and receive personal attention without regard to your race, national origin, gender, gender identity, age, sexual orientation, or religious affiliation.
  • To not be discriminated against due or preexisting conditions, medical condition, claims experience, receipt of health care, medical history, genetic information, evidence of insurability, or disability. 
  • To an open discussion of appropriate home and community services or medically necessary treatment options for your conditions, regardless of cost or benefit coverage. 
  • To get a second medical opinion for medical and surgical concerns. 
  • To voice grievances or appeals about Neighborhood or the care provided by its practitioners and/or agencies. 
  • To contact the State's Enrollee Ombudsman for assistance with any matter related to the care or service provided by Neighborhood or its practitioners and/or agencies  
  • To make recommendations about Neighborhood’s Member Rights and Responsibilities policies. 
  • To refuse treatment, and if you do, it will not affect your future treatment. 
  • To receive information on available treatment options and alternatives. 
  • To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation. 
  • To request and receive a copy of your medical records, and request that they be amended or corrected. 
  • To be given health care services and reasonable accommodations. 
  • To receive health care services covered by Neighborhood without getting a bill after Neighborhood pays, by one of our providers or practitioners. 
  • To exercise your rights, and that the exercise of those rights does not negatively affect the way Neighborhood and its providers treat you. (Violation of this policy by Neighborhood staff will result in disciplinary actions.) 
  • To understand the requirements and benefits of the plan.
  • To receive member materials in a manner that can easily be understood, including formats that take into consideration members with special needs.
  • To include an inpatient hospital stay following childbirth for mothers and newborns. 

Member Responsibilities 

As a Neighborhood member, you have the following responsibilities:

  • To choose a PCP and primary care site. Your PCP will coordinate all of your medical care. You may change your PCP at any time by calling Neighborhood Member Services. 
  • To have all of your medical care provided by, or arranged by, a provider in the Neighborhood network. This rule does not apply to emergency or urgently needed care, kidney dialysis services at a Medicare-certified dialysis facility and family planning services.
  • To carry your Neighborhood member ID and your Rhode Island Medical Assistance card with you. 
  • To provide, to the extent possible, information that Neighborhood and its practitioners and providers need to care for you. 
  • To learn about your health problems and help plan treatment you and your provider agree on. 
  • To follow the plans and instructions for care that you have agreed on with your providers. 
  • To talk with your PCP about all specialty care. If you need a specialist, your PCP will work with you to make sure you get quality care. 
  • To let Neighborhood know about any changes to your name, home address, telephone number, or if you have other insurance coverage. 

Call Neighborhood Member Services if you have any questions about your rights and responsibilities. Member Services can be reached at 1-844-812-6896 (TTY 711), 8 am to 8 pm, Monday – Friday; 8 am to 12 pm on Saturday. On Saturday afternoons, Sundays and federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free.

Have questions?

Please call us at 1-844-812-6896 (TTY 711), 8 am to 8 pm, Monday – Friday; 8 am to 12 pm on Saturday. On Saturday afternoons, Sundays and federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free. 

Neighborhood Health Plan of Rhode Island is a health plan that contracts with both Medicare and Rhode Island Medicaid to provide the benefits of both programs to enrollees.

This information is available for free in other languages. Please call our Member Services at 1-844-812-6896 (TTY 711), 8 am to 8 pm, Monday – Friday; 8 am to 12 pm on Saturday. On Saturday afternoons, Sundays and federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free.

Esta información está disponible de forma gratuita en otros idiomas. Por favor llame a nuestro Departamento de Servicios para Miembros al 1-844-812-6896 (TTY 711) de 8 am a 8 pm, lunes-viernes; sábados de 8 am a 12 pm. Los sábados por la tarde, domingos y días festivos federales, se le pedirá que deje un mensaje. Su llamada será devuelta dentro del siguiente día laborable. La llamada es gratuita.

Estas informações estão disponíveis gratuitamente noutros idiomas. Por favor telefone para os Serviços dos Membros em 1-844-812-6896 (TTY 711), das 8 às 20 horas, de Segunda a Sexta-feira; e das 8 às 12 (meio-dia) aos Sábados. Nos Sábados à tarde, Domingos e feriados federais, poderá ser-lhe pedido que deixe uma mensagem. A sua chamada será respondida no próximo dia útil. Esta chamada é grátis.

Our plan can also give you materials in Spanish and Portuguese and in formats such as large print, braille, or audio. Call Neighborhood INTEGRITY Member Services to make a standing request to receive your materials now and in the future, in your requested language or alternate format.

Last Updated January 9, 2017, 3:58 pm

H9576_ WebRandR CMS Approved 9/13/16