Member Rights & Responsibilities

Member Rights

Every member or legal designee of Leon Health, Inc. has certain rights and protections related to their health care. These rights and protections are for everyone with Medicare and are as follows:

• Be treated with privacy, respect, dignity, and consideration at all times.
• Be protected from discrimination. Every company or agency that works with Medicare must obey the law. They can’t treat you differently because of your race, color, national origin, disability, age, religion, or sex.
• Have your personal and health information kept confidential.
• Be able to refuse participation in any research.
• Get information regarding advance directive information.
• Get information in a way you understand from Medicare, health care providers, and, under certain circumstances, contractors.
• Be able to see information in your record and know who it has been shared with.
• Get timely access to covered services and drugs.
• Get understandable information about to help you make health care decisions, including:
• What’s covered.
• What Medicare pays.
• How much you have to pay.
• What to do if you want to file a complaint or appeal.
• Have your questions about Medicare answered.
• Have access to doctors, specialists, and hospitals.
• Learn about your treatment options in clear language that you can understand and participate in treatment decisions.
• Get health care services in a language you understand and culturally sensitive way by using interpretive services or any other means that will assist in obtaining the services needed.
• Request materials and/or assistance in language and formats other than written English, such as Braille, Audio or Sign language, if necessary.
• Get Medicare-covered services in an emergency.
• Get a decision about health care payment, coverage of services, or prescription drug coverage.
• Get information on why something is not covered.
• When a claim is filed, you will get a notice letting you know what will and won’t be covered.
• If you disagree with the decision of your claim, you have the right to file an appeal.
• Request a review of specific decisions about health care payment, coverage of services, or prescription drug coverage.
• If you disagree with a decision about your claims or services, you have the right to appeal.
• File complaints (sometimes called “grievances”), including complaints about the quality of your care.
• Obtain information regarding your providers credentials.
• Expect that Leon Health will provide its Notice of Privacy Practices without his/her request.
• Receive information regarding malpractice insurance of providers upon request.
• Providers who lack malpractice insurance must post such information in a prominent location in their office (verified through provider site visits)

Member Responsibilities

Members of legal designees have a responsibility to:

1. Understand covered services and rules
2. Provide accurate health history, including information about mediation and over- the-counter products, dietary supplements, and allergies or sensitivities.
3. Follow the treatment and care prescribed by the providers.
4. Inform providers and plan any living wills, medical power of attorney, or other directives affecting care.
5. Accept personal financial responsibility for costs not covered by the plan.
6. Treat health care providers, staff, and others with respect.
7. Ensure that all demographic information is up to date.
8. Report any identified Fraud, Waste or Abuse.

H4286_MEMBERRIGHT2021_C