Rights and Responsibilities

Know Your Rights

Members have certain rights concerning your health care. You also have certain responsibilities. These are described below.

Your Rights

  1. You have the right to be treated with respect and with recognition of your dignity. You also have the right to privacy. See our Privacy Practices.
  2. You have the right to be told about and understand any illness you have.
  3. You have the right to be told in advance – in a manner you understand – of any treatment(s) and alternatives that a Provider feels should be done.
  4. You have the right to take part in decisions regarding your health care. This includes the right to refuse treatment as far as the law allows, and to know what the outcome may be.
  5. You have the right to have an open and honest discussion of appropriate or Medically Necessary treatment options for your health conditions, regardless of cost or benefit coverage. You may be responsible for payment of services that are not Covered Services.
  6. You have the right to expect your healthcare Providers to keep your records private, as well as anything you discuss with them. No information will be released to anyone without your consent, unless allowed or required by law.
  7. You have the right to ask for an interpreter when you receive health care. Call the Member Services Department if you need this help.
  8. You have the right to request an interpreter when you call or visit Well Sense Health Plan or Beacon Health Strategies (for Behavioral Health). Call the Member Services Department if you need this help.
  9. You have the right to choose your own Primary Care Provider (PCP) from our Provider Network. You must call the Member Services Department to change your PCP.
  10. You have the right to receive health care within the timeframes described in the “How Long It Should Take To Get Care” part of Section 6 (Your Health Care). You have the right to file a Standard Appeal if you do not receive your care within those timeframes.
  11. You have the right to voice a complaint and file a Grievance with the Well Sense Health Plan Member Services Department, Beacon Health Strategies, and/or New Hampshire Medicaid customer service center about services you received from us or from a Provider. You also have the right to Appeal certain decisions made by us or Beacon. Grievances and Appeals are described in the Member Handbook, Section 10 (Inquiries, Grievances and Appeals).
  12. You have the right to talk about your health records with your Provider and get a complete copy of those records. You also have the right to request a change to your health records. See Section 11 (Notice of Privacy Practices) for more information.
  13. You have the right to know and receive all of the benefits, services, rights and responsibilities you have under Well Sense Health Plan, New Hampshire Medicaid, and applicable federal and state regulations.
  14. You have the right to have this Member Handbook and any printed materials from us translated into your primary language, and/or to have these materials read aloud to you if you have trouble seeing or reading. Oral interpretation services are available upon request and free of charge.
  15. You have the right to ask for a Second Opinion about any health care that your PCP advises you to have. We will pay for the cost of your Second Opinion visit.
  16. You have the right to receive Emergency care: 24 hours a day, seven days a week. Please see Section 6 (Your Health Care) for information about Emergencies.
  17. You have the right to be free from any form of physical restraint or seclusion that would be used as a means of coercion, force, discipline, convenience or retaliation.
  18. You have the right to freely exercise these rights without adversely affecting the way Well Sense Health Plan, Network Providers or New Hampshire Medicaid treats you.
  19. You have the right to receive health treatment from our Network Providers without regard to race, age, gender, sexual preference, national origin, religion, health status, economic status, or physical disabilities. Network Providers are not permitted to engage in any practice that constitutes unlawful discrimination against Members under any state or federal law or regulation.
  20. You have the right to disenroll from Well Sense Health Plan and change to another Managed Care plan. To do so, you must call New Hampshire Medicaid customer service center. To make this change, you must meet Disenrollment requirements of New Hampshire Medicaid.
  21. You have the right to receive information about:
    • Well Sense Health Plan
    • Our services
    • Network Providers
    • Your rights and responsibilities
  22. You have the right to make recommendations about this Rights and Responsibilities statement.

Your Responsibilities

  1. You should tell your healthcare Provider your health complaints clearly. Provide as much information as possible.
  2. You should tell your healthcare Provider about yourself and your health history.
  3. You should talk to your PCP about seeking the services of a Specialist before you go to other Network Providers (except in an Emergency).
  4. You should treat your healthcare Provider with dignity and respect.
  5. You should keep appointments, be on time, and call in advance if you’re going to be late or have to cancel.
  6. You should learn about your health problems and any recommended treatment. Consider the treatment before it’s performed.
  7. You should partner with your healthcare Provider and work out treatment plans and goals together.
  8. You should follow the instructions and plans for care that you and your healthcare Provider have agreed to. Consider that refusing treatment recommended by your healthcare Provider might harm your health.
  9. You should authorize your PCP to get copies of all your health records.
  10. You should know that, to be Covered by us, you must receive all your health care from Network Providers, except:

    if you need Emergency care

    • for Family Planning Services
    • for Urgent Care when you are temporarily traveling outside our Service Are
    • if we give an Authorization in advance for you to get care from an out-of-Network Provider.

    For services not Covered by Well Sense Health Plan that you get using your New Hampshire Medicaid Card, you may receive care from any New Hampshire Medicaid contracted Provider.

  11. You must not allow anyone else to use your Well Sense Health Plan or New Hampshire Medicaid ID cards to get healthcare services. See the “Reporting Health Care Fraud” section below.
  12. You must notify our Member Services Department and the New Hampshire Medicaid customer service center when you believe that someone has purposely misused Well Sense Health Plan or New Hampshire Medicaid benefits or services.
  13. You must notify our Member Services Department and the New Hampshire Medicaid customer service center if you change your address or phone number.
  14. You are responsible for payment of services not included in Appendix A (Covered Services), or for those in Appendix B (Excluded Services).

Reporting Healthcare Fraud

If you know anyone that has committed, or is trying to commit, healthcare Fraud, please call our confidential compliance hotline at 888-411-4959. You do not need to identify yourself. Examples of healthcare Fraud include:

If you get a bill for healthcare services you never received
People loaning their health insurance ID cards to others for the purpose of receiving healthcare services, supplies or prescription drugs
Being asked to provide false or misleading healthcare information