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It is up to you to:
- Establish you or your children with a primary care provider (PCP) within 30 days of entering the First Choice plan.
- Not change your child's PCP without approval from First Choice.
- Inform First Choice of any loss or theft of your ID card.
- Present your First Choice ID card whenever you see any doctor or visits a hospital, clinic or pharmacy.
- Become familiar with First Choice procedures. If you have any questions or require additional information, contact the First Choice Member Services Department.
- See your doctor regularly for preventive services such as prenatal care, well-child visits, adult physicals and well-woman exams.
- Provide, to the extent possible, information that First Choice and its healthcare professionals and providers need in order to care for you.
- Treat your PCP(s) and their staff with kindness and respect.
- Help the PCP(s) obtain all your medical records and fill out new ones.
- Participate in understanding your health problems and follow the recommended treatment of care from your doctor. You must let the doctor know the reasons the treatment cannot be followed as soon as possible.
- Obtain a referral from your PCP(s) before you go to a specialist or to the hospital. Only go to the specialist or hospital your PCP(s) recommended.
- Go to the emergency room only for emergencies.
- Call your PCP(s) as soon as you or a family member feels ill. Do not wait. If you think you have a life-threatening emergency, go to your closest hospital.
- Be on time for all appointments. If you cannot make an appointment, please cancel at least 24 hours in advance of your originally scheduled time.
- Notify First Choice if your or your child/children's name, address or phone number changes.
- Inform First Choice of any change in your legal status regarding your authority to make decisions on behalf of your child or children.
You have the right to:
- Be treated with respect and with consideration for your dignity and privacy.
- Participate in decisions regarding your healthcare, including the right to refuse treatment.
- Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation, as stated in the federal regulations on the use of restraints and seclusion.
- Request and receive a copy of your medical records, and request that they be amended or corrected.
- Receive healthcare services that are accessible, are comparable in amount, duration and scope to those provided under Medicaid Fee-for-Service and are sufficient in amount, duration and scope to reasonably be expected to achieve the purpose for which the services are furnished.
- Receive services that are appropriate and are not denied or reduced solely because of diagnosis, type of illness or medical condition.
- To receive all information - enrollment notices, informational materials, instructional materials, available treatment options and alternatives in a manner and format that is easily understood.
- Receive assistance from both the South Carolina Department of Health and Human Services and First Choice in understanding the requirements and benefits of the plan.
- Receive oral interpretation services free of charge for all non-English languages, not just those identified as prevalent.
- Be notified that oral interpretation is available and how to access those services.
- As a potential member, to receive information about the basic features of managed care, which populations may or may not enroll in the program and First Choice responsibilities for coordination of care in a timely manner in order to make an informed choice.
- Receive information on First Choice services, to include, but not limited to:
- Benefits covered.
- Procedures for obtaining benefits, including any authorization requirements.
- Any cost sharing requirements.
- Service area.
- Names, locations, telephone numbers of and non-English language spoken by current contracted providers, including at a minimum, primary care physicians, specialists and hospitals.
- Any restrictions on your freedom of choice among network providers.
- Providers not accepting new patients.
- Benefits not offered by First Choice but available to you, and how to obtain those benefits, including how transportation is provided.
- Receive a complete description of disenrollment rights at least annually.
- Receive notice of any significant changes in the benefits at least 30 days before the intended effective date of the change.
- Receive information on the grievance, appeal and fair hearing procedures.
- Receive detailed information on emergency and after-hours coverage, to include, but not limited to:
- What are emergency medical conditions, emergency services and post-stabilization services.
- That emergency services do not require prior authorization.
- The process and procedures for obtaining emergency services.
- The locations of any emergency settings and other locations at which providers and hospitals furnish emergency services and post-stabilization services covered under the contract.
- Your right to use any hospital or other setting for emergency care.
- Post-stabilization care services rules (detailed in 42 CFR 422.113c).
- Receive First Choice policy on referrals for specialty care and other benefits not provided by the member's PCP.
- Have your privacy protected in accordance with the privacy requirements (45 CFR parts 160 and 164 subparts A and E to the extent that they apply).
- Exercise these rights without adversely affecting the way First Choice, its providers or the South Carolina Department of Health and Human Services treats members.
- To have a candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage.
- To voice grievances or appeals about First Choice or the care it provides.
- To make recommendations regarding First Choice's member rights and responsibilities.
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