Member Rights and Responsibilities

Our Commitment to You
Maricopa Health Plan’s goal is to provide high-quality medical care and advanced medical treatment. We also promise to listen, treat you with respect, and understand your individual needs. Members have rights and responsibilities. The following is a description of your rights and responsibilities.

Clicking a category below will expand the section to reveal all documents and links to information deemed important for the selected category.

Helpful resources for your healthcare needs
  • Grievance and Appeals
    • It is very important to MHP that you have a way to share your concerns with us. We have a section in our handbook that tells you about your rights. Not all our members ask for a handbook. So, we want to make sure you get to see and read your rights.

      Below we have pulled the sections that we think you need to know. It’s your right to file a complaint if you are not happy with us or our provider. Let us know how we can make things right.

      Let us know if we did something wrong. Please call us at (800) 582-8686 and we can listen to your concerns. We can help you file a complaint if needed.
    • 2012 Member Handbook
      Grievances and
  • Member Responsibilites
    • It is your responsibility to provide, to the best of your knowledge, information to help the Maricopa Health Plan staff care for you.

      It is your responsibility to follow instructions and guidelines given by those providing health care.

      It is your responsibility to know the name of your assigned PCP.

      It is your and your family members’ responsibility to be considerate of the rights and property of patients and staff. This includes smoking and visitation policies.

      It is your responsibility to pay your co-payments for care received as soon as possible.

      It is your responsibility to schedule appointments during medical office hours whenever possible before using urgent care.

      It is your responsibility to arrive on time and to let the medical office know in advance when you can’t keep an appointment.

      It is your responsibility to bring immunization records to every appointment for children under 21 years of age.

      It is your responsibility to watch over children with you at all times.

      It is your responsibility to cancel your ride when you cancel your appointment.

      It is your responsibility to NOT behave in a way that disrupts and/or does not allow a doctor to serve you or another patient in a safe way.

    • 2013 Member Handbook
  • Member Rights
      1. 1.You will receive care that meets your needs in a way that doesn’t judge race, gender, religious beliefs, values, language, how much a person is able to do, age, handicap, or ability to pay.
      2. 2.You will be treated with respect and dignity. We understand your need for privacy and confidentiality including protection of any information that identifies you.
      3. 3.You will be treated in a safe, supportive and smoke-free environment.
      4. 4.You have the right to information about Maricopa Health Plan’s services, health care providers, admission, transfer, discharge, billing policies, and members’ rights and responsibilities.
      5. 5.You have the right to choose your primary care physician within the limits of the Maricopa Health Plan network.
      6. 6.The law states that you have the right to read or get copies of your medical records at no cost to you. However, your right to access medical records may be denied if the information is psychotherapy notes, compiled for, or in a reasonable anticipation of a civil, criminal or administrative action, protected health information subject to the Federal Clinical Laboratory Improvement Amendments of 1988 or exempt pursuant to 42 CFR 493.3(a)(2).
        • You have the right to have MHP amend or correct your medical records.
        • You have the right to review your medical records if you are denied access to inspect or obtain a copy.
      7. 7.You have the right to help in decision making about your health care and Advance Directives (decisions about what kind of care you would like to receive if you become unable to make medical decisions).
      8. 8.You have the right to complain about Maricopa Health Plan and/or care provided.
      9. 9.You have the right to be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
      10. 10.Your wishes are important. You have the right to the information needed to help you make informed decisions. Here is a list of some, but not all of your rights:
        • You can accept or refuse any treatment. You will be informed of any consequences of refusing treatment.
        • You can receive information on available treatment options and alternatives.
        • You can make Advance Directives and appoint someone to make healthcare decisions for you. You or your representative can change your Advance Directives at any time.
        • You or someone who represents you can take part in resolving problems about your care decisions.
      11. 11.You have the right to the following:
        • You can be told about Physician Incentive Plans that affect referral services.
        • You have the right to know that MHP is required to participate in a stop-loss insurance program.
        • You can be told the types of plans Maricopa Health Plan uses for compensation.
        • You can get a summary of member survey results.
      12. 12.You have the right to know of providers who speak a language other than English.
      13. 13.You have the right to have a list of available PCPs.
      14. 14.You have the right to a second opinion from a qualified health care professional within MHP’s network. If an in-network second opinion is not available, you have the right to have a second opinion arranged outside of the MHP network at no cost to you.
      15. 15.You have the right to request a copy of the Notice of Privacy Practices at no cost to you. The notice describes Maricopa Health Plan’s privacy practices and how we use health information about you and when we may share that health information with others.

  • Moving Away from the Service Area
    • If you move out of the country or state of Arizona, you will not be eligible for any AHCCCS plans. Before you move, tell:

          *Your health plan, Maricopa Health Plan, by calling Customer Care.
          *Your PCP.
          *The AHCCCS eligibility office.
          *Your SSI office, if you are receiving SSI benefits.
          *DES, if you receive TANF, food stamps or are on SOBRA.
          *For KidsCare (Title XXI) members, please call AHCCCS at 602-417-5437 or the toll-free statewide number, 1-877-764-5437.

      You could lose your care paid for by AHCCCS if you do not tell these offices you are moving.

      Call Customer Care if you have questions about your enrollment or call AHCCCS at 602-417-4000.

      If you move to another county you should:

          *Tell the eligibility office.
          *Call the AHCCCS office to choose a new plan if you are AHCCCS-eligible.
          *Call your new plan and choose a provider.

      Call Customer Care if you have any questions about what to do or call AHCCCS at 602-417-4000.

    • 2012 Member Resources
      Moving Away from the Service
  • Other Insurance
    • Coordination of Benefits (COB) If you are a member with “other insurance” or are “dual eligible” (which means that you also have Medicare coverage), please take a moment to call Customer Care to let us know. When you call us, we will make sure we have the other insurance listed in our system. You may also call the AHCCCS eligibility office to let them know. AHCCCS will then pass the information on to us. Remember, this also includes insurance coverage by divorce or if your child had insurance that is paid by your former spouse.

      Sometimes, members with other types of insurance such as Tricare or other commercial plans are approved for AHCCCS. Maricopa Health Plan is responsible for making any co-payment, coinsurance or deductibles, even if the services are provided outside of the Maricopa Health Plan Plan Network.

      If a third party insurer (other than Medicare) requires the member to pay any co-payment, coinsurance or deductible, MHP is responsible for making these payments, even if the services are provided outside of the network. MHP is not responsible for paying coinsurance and deductibles that are more than MHP would have paid for the entire service per the contract with the provider performing the service, or the AHCCCS equivalent.

      Special Information for our Members who have Medicare Coverage:
      If you are a “dual eligible” member, it often means that you have additional benefits that may not be covered under AHCCCS. When we know about your other insurance, it helps us coordinate the care you receive with the other plan. If you have Medicare coverage and you see a doctor that is not on our plan, the charges may not be covered. If you choose to do that without our approval, Maricopa Health Plan may not pay for those services because they were done by a doctor that is not on our plan. It is important that you work with your PCP to be referred to the right doctors. (This does not include emergency services.) Maricopa Health Plan will not cover co-pays or deductibles for services provided outside of the network without authorization. So why should you call Customer Care and let us know? Because it will help you get the maximum benefits from both insurance plans!

      NOTE: If you are on a Medicare HMO and have Maricopa Health Plan (MHP), you MUST choose a PCP that is contracted with both plans in order for medical services to be covered.
    • 2012 Member Handbook