Member Rights and Responsibilities

As a MedCost member, you have certain rights and responsibilities.

As a member, you have the right to:

• Receive information about your coverage and health plan, including a list of doctors and health care services covered.

• Be treated with respect from MedCost and the doctors who are part of the MedCost provider network.

• Receive an explanation of why MedCost denied a request for treatment or health care service, and the guidelines used to reach that decision.

• Receive information that is clear and factual to help you make your own health care choices.

• Receive all necessary information and support to take an active role in your health care and discuss treatment options with your doctor without regard to cost or benefit coverage.

• Engage with doctors in making decisions about your health care.

• Expect that MedCost will take measures to maintain the privacy of your health information and protect your health care records, as outlined in the MedCost Notice of Privacy Practices.

• Voice complaints and expect a fair and quick appeals process for addressing any concerns you may have with MedCost.

• Make suggestions regarding MedCost's member rights and responsibilities policies.

• Receive information about MedCost, its services, its health care providers and your rights and responsibilities.

• Be treated courteously with recognition of your dignity and right to privacy.

• Receive information about the MedCost programs and services provided on behalf of your employer, including staff qualifications and information about MedCost’s relationship with relevant subcontractors, if applicable.  

• Decline participation or disenroll from MedCost Care Management programs.  Program disenrollment due to lack of response from the member may impact program incentives or disincentives. Please refer to your plan document for additional details.

• Receive information about MedCost Care Management staff handling your case needs and how to request a change in assigned staff.

• Receive information in the language you speak, for most languages, upon request.

• Receive certain protections against balance billing under the No Surprises Act. 

As a member, you have the responsibility to:

• Present your MedCost ID card each time you visit a doctor or hospital, or receive any type of health care service.

• Access and read your Summary Plan Description and all other materials provided to you by MedCost.

• Call MedCost when you have a question.

• Follow the treatment plan prescribed by your doctor and notify him or her if you choose not to comply or if you withdraw from participation in a MedCost Care Management program.

• Provide MedCost and your doctors with complete information about your illness, accident, or health care issues, which may be helpful in determining a treatment plan.

• Understand your health concerns and participate in developing treatment goals.

• Follow the mutually agreed-upon case management plan or notify your case manager if you can no longer follow the plan, including disenrollment from the program.

• Make appointments for non-emergency medical care and keep your appointments. If it is necessary to cancel an appointment, give the doctor's office at least 24-hours’ notice.

• Play an active part in your health care.

• Be courteous to network doctors, their staff and MedCost employees.

• Give prompt notification of health plan updates, including, but not limited to, coverage additions and terminations.

• Protect your MedCost ID card from improper use.

• Follow the rules outlined by your health plan.