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 to 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 file 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 timely access to 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.
- To leave the plan. If you chose to leave the plan you will get most of your health care services through original Medicare or a Medicare Advantage plan. If you leave our plan, you will receive your Medicaid services directly from Rhode Island Medicaid Fee for Services (FFS).
Member Responsibilities
As a Neighborhood member, you have the following responsibilities:
- To choose a Primary Care Provider (PCP) and primary care site. Your PCP will coordinate 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 card 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.
- To read the Neighborhood INTEGRITY Member Handbook to learn what is covered and what rules you need to follow to get covered services.
- To be considerate. We expect all our members to respect the rights of other patients. We also expect you to act with respect in your providers’ offices, hospitals, and when interacting with our staff.
- Pay what you owe. As a plan member you are responsible for the following payments:
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- Medicare Part A and Medicare Part B premiums, for most Neighborhood INTEGRITY Members, Medicaid pays for your Part A premium and for your Part B premium.
- If you get LTSS, you may have to pay for part of the cost of services. The amount is determined by Rhode Island Medicaid.
- If you get any services or drugs that are not covered by our plan, you must pay the full cost.
- If you disagree with our decision to not cover a service or a drug, you can make an appeal.
Questions?
Please call us at 1-844-812-6896 (TTY 711), 8 a.m. to 8 p.m., Monday – Friday. 8 a.m. to 8 p.m., 8 a.m. to 12 p.m. on Saturday. On Saturday afternoons, Sundays, and 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.
Last updated: October 25, 2023 @ 5:07 pm
H9576_ WebRandR24 Approved, 10/24/2023