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Citrus Medicare- Member Rights And Responsibilities

Member Rights

As you consider becoming a member of Citrus Health Care’s CitrusCare, it is important that you know what your rights and responsibilities will be so you can take full advantage of your benefits.

Individual Dignity

To have your individual dignity and privacy respected at all times.
To receive a prompt and reasonable response to a question or request regarding your medical services.
To know what patient support services are available, including whether an interpreter is available if you do not speak English.
To extend your rights to any person who may have legal responsibility to make decisions regarding your medical care on your behalf.
To file a complaint, grievance or appeal regarding any decision made by Citrus Health Care without retaliation from Citrus Health Care or providers, and expect problems to be investigated and addressed without discrimination.

Access to Health Care

To have impartial access to medical treatment or accommodations and to exercise your rights regardless of your race, ethnicity, national origin, religion, sex, age, physical or mental disability, sexual orientation, genetic information, or source of payment.
To receive treatment for any emergency medical condition that will deteriorate from failure to receive medical treatment.
To have timely access to your Primary Care Physician, medically necessary referrals, and continuity of care.

Treatment Information Disclosure

To know the name, function and qualifications of each health care provider who is providing medical services.
To be provided with information concerning diagnoses, planned course of treatment, alternatives, risks, and prognosis.
To refuse any treatment, except as otherwise provided by law.
To candidly discuss all treatment options for your condition, regardless of cost or benefit coverage.

Financial Disclosure

To be given, upon request, full information and necessary counseling on the availability of known financial resources for care.
A person who is eligible for Medicare has the right to know, upon request and in advance of treatment whether the health care provider or health care facility accepts the Medicare assignment rate.
To receive, upon request, prior to treatment, a reasonable estimate of charges for medical care.
To receive a copy of a reasonably clear and understandable, itemized bill and, upon request, to have the charges explained.
To know what services are covered benefits, what costs are paid and what you are responsible for paying (for example a co-payment).
To be provided with a description of and a link to the performance outcome and financial data published by the Agency for Health Care Administration.

Information Disclosure

Upon your request you will receive from Citrus Health Care:

A detailed description of the referral process for health care services.
A description of the process used to determine whether health care services are medically necessary, including but not limited to experimental or investigational medical treatments.
A description of the quality assurance program.
The policies and procedures relating to prescription drug benefits.
The policies and procedures relating to confidentiality and disclosure of medical records.
The process used to credential and reimburse contracted providers.

Member Responsibilities

Provide the health care provider, to the best of your knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications, and other matters relating to your health
Report unexpected changes in your condition to the health care provider
Report to the health care provider whether you understand the contemplated course of action and what is expected of you
Follow the treatment plan recommended by the health care provider
Keep appointments, and, when you are unable to do so for any reason, notify the health care provider or facility
Understand that you are responsible for your actions if you refuse treatment or do not follow the health care provider's instructions
Notify Citrus Health Care before you change your address

Upon Disenrollment

Member Rights and Responsibilities upon disenrollment:

You have the right to end your membership during specific enrollment periods, the Annual Enrollment Period and the Medicare Advantage Open Enrollment Period.
You have the right to make a complaint if we end your membership in our plan.
You must continue to get your medical care and drugs through our plan until your membership ends. If you will be changing to Original Medicare you may have a special temporary right to buy a Medigap policy even if you have health problems. You can call Medicare at 1-800-633-4227 for more information. TTY users should call 1-977-486-2048.

If you disenroll from a Medicare prescription drug plan and go without creditable prescription drug, you may need to pay a late enrollment penalty if you join a Medicare drug plan later coverage.