Member Rights
- Be treated with respect, dignity, and consideration for privacy.
- Get the services you need 24 hours a day, seven days a week. This includes emergencies.
- Be told about your health problems.
- Get information about treatments, your treatment choices, and how they will help or harm you.
- Participate with providers in making decisions about your health care.
- Refuse treatment and get information about what might happen if you refuse treatment.
- Refuse care from specific providers.
- Know that we will keep your records private according to law.
- Request and receive a copy of your medical records. You also have the right to ask to correct the records.
- Get notice of our decisions if we deny, reduce or stop a service, or deny payment for a service.
- File a grievance or appeal with us. You can also file a complaint with the Minnesota Department of Health.
- Request a State Fair Hearing with the Minnesota Department of Human Services (also referred to as “the State”). You may request a State Fair Hearing before or at any time during our appeal process. You do not have to file a grievance or an appeal with us before you request a State Fair Hearing.
- A clear explanation of covered nursing home and home care services.
- Give written instructions that inform others of your wishes about your health care. This is called a “health care directive.” It allows you to name a person (agent) to decide for you if you are unable to decide, or if you want someone else to decide for you.
- Choose where you will get family planning services.
- Get a second opinion for medical, mental health, and chemical dependency services.
- Be free of restraints or seclusion used as a means of: coercion; discipline; convenience; or retaliation.
- Request a copy of this Certificate of Coverage at least once a year.
- Get the following information from us, if you ask for it:
- Whether we use a physician incentive plan that affects the use of referral services
- The type(s) of incentive arrangement used
- Whether stop-loss protection is provided
- Results of a member survey if one is required because of our physician incentive plan
- Results of an external quality review study from the State
- Make recommendations about our rights and responsibilities policy.
- Exercise the rights listed here.
Members who have Medicare have the additional following rights:
- The right to assistance, in identifying services needed to maintain the Enrollees who receive LTCC’S in the most inclusive environment, pursuant to M.S. § 256B.0911, subd. 1a(1).
- The right to be offered choices in types of Home and community based services wherever possible within a system of identified Providers.
NOTE: South Country Health Alliance (SCHA) does not specifically reward practitioners, staff or other individuals for issuing denials of coverage. Utilization Management decision-making is based on appropriateness of care and service and the existence of coverage. SCHA does not use financial incentives to encourage barriers to care and service or to encourage decisions that result in underutilization.