Patients' rights and responsibilities

Moda Health recognizes the specific needs of its members and maintains a mutually respectful relationship with them.

Members’ rights

Members have the right to:

  • Be treated with respect and dignity
  • Know their rights and responsibilities. Members will be given information about their health plan and how to use it. Members will also be given information about the providers who care for them. This information will be provided in a way that members can understand.
  • Make recommendations regarding Moda Health's members' rights and responsibilities policy
  • Participate in decision-making regarding their healthcare – members have a right to participate in a discussion of appropriate or medically necessary treatment options for their conditions, whether or not the cost or service is covered by Moda Health
  • Have access to urgent and emergency services, 24 hours a day, seven days a week
  • Refuse care – members have the right to be advised of the medical result of their refusal
  • Receive services as described in their plan booklets
  • Have their medical and personal information remain private – personal information will be handled in compliance with state and federal law and will be given to third parties only as necessary to administer the plan, as required by law or as permitted by the member.
  • Change to a new primary care physician (PCP) (not all plans require members to choose a PCP)
  • File a complaint or appeal about any aspect of the plan – members have a right to a timely response to their complaint or appeal. Members are welcome to make suggestions to the plan.
  • File a statement of wishes for treatment with their physician – a statement of wishes for treatment is also known as an Advanced Directive. Members also have the right to file a power of attorney. A power of attorney allows the member to give someone else the right to make healthcare choices when the member is unable to make them.
  • Receive and utilize free language assistance services, including interpretation and translation services

Patients’ responsibilities

Members have the responsibility to:

  • Read the member handbook to make sure they understand the plan – members are advised to call Medical Customer Service or Pharmacy Customer Service with any questions
  • Select a PCP for those plans that require it
  • Treat all providers and their staff with courtesy and respect
  • Communicate with professional staff and Moda Health so that they have the information necessary to provide good healthcare
  • Understand their health problems and participate in making decisions about their medical care and forming a treatment plan, to the degree possible
  • Follow plans and instructions for the care they have agreed to with their provider
  • Seek health services from their chosen PCP, unless the plan states otherwise, such as in the case of an emergency (not all plans require members to choose a PCP)
  • Use urgent and emergency services appropriately
  • Obtain approval from their PCP before going to a specialist, if required by the plan
  • Present their member identification card when seeking medical care
  • Notify providers of any other insurance policies that might provide coverage
  • Reimburse Moda Health for any third-party payments they receive
  • Keep appointments and arrive on time – if this is not possible, members must call ahead to let the provider know they will be late or cannot keep their appointment
  • Seek regular health checkups and preventive services
  • Provide adequate information to the plan to properly administer benefits and resolve any issues or concerns that may arise

Members who have any questions about these rights and responsibilities can call the Moda Health Medical Customer Service department.