Member Rights & Policies

As a CountyCare member, we must honor your rights and cannot punish you when you exercise your rights.

Member Rights:

  • Be treated with respect and dignity at all times.
  • Have your personal health information and medical records kept private except where allowed by law.
  • Receive information about CountyCare Member Rights and Responsibilities. You also have the right to suggest changes to this policy.
  • Receive, in a reasonable amount of time, information about CountyCare Health Plan, and its services, providers, and polices.
  • Participate with providers in making decisions about your health care treatment, including the right to refuse treatment.
  • Have a candid discussion with your provider about appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage.
  • Receive information on available treatment options and alternatives. This includes the right to ask for a second opinion. Providers must explain your treatment options in a way you understand.
  • Be protected from discrimination.
  • Receive information, including the Member Handbook, in other languages such as audio, large print or Braille.
  • Request an interpreter when needed.
  • File a complaint (sometimes called a grievance), or appeal about CountyCare or the care you received without fear of punishment of any kind. You can request an interpreter during any complaint or appeal process.
  • Appeal a decision made by CountyCare on the phone or in writing.
  • Request and receive a copy of your medical records and in some cases request that they be amended or corrected.
  • Choose your own primary care provider (PCP) from CountyCare. You can change your PCP at any time.
  • Receive health care services in ways that comply with federal and state law. CountyCare must make covered services accessible to you. Services must be available 24 hours a day, seven days a week.
  • Be free from any form of restraint or seclusion used for convenience or as a way to force, discipline, or retaliate.

Member Responsibilities:

  • Treat your doctor and the office staff with courtesy and respect.
  • Carry your CountyCare ID card with you when you go to your doctor appointments and to the pharmacy to pick up your prescriptions.
  • Keep your appointments and be on time for them.
  • If you cannot keep your appointments cancel them in advance.
  • Provide as much information as possible so that CountyCare and its providers can give you the best care possible.
  • Know your health problems and take part in making decisions about your treatment goals as much as possible.
  • Follow the instructions and treatment plan agreed upon by you and your doctor.
  • Tell CountyCare and your caseworker if your address or phone number changes.
  • Tell CountyCare and your case worker if you have other insurance and follow those guidelines.
  • Read your member handbook so you know what services are covered and if there are any special rules.

Member Grievances and Appeals

CountyCare has a process for members to give us feedback. You can file a grievance when you have a complaint. You can file an appeal when a service is denied.

Member Grievances

A member grievance is a complaint about any matter other than a denied, reduced, or terminated service or item. CountyCare takes member grievances seriously. We want to know what is wrong so we can make our services better. Let us know right away if you have a grievance. CountyCare has special procedures in place to help members who file grievances. We will do our best to answer your questions to resolve your concern. Filing a grievance will not affect your health care services or your benefits coverage.

To have someone else act on your behalf in a grievance, complete and return the Authorized Representative form. The person listed will be accepted as your authorized representative. We are unable to speak with this person on your behalf unless this form is completed, signed, and returned to us.

These are examples of when you might want to file a grievance:

  • Your provider did not respect your rights.
  • You did not get an appointment in a timely fashion.
  • You were unhappy with the quality of care you received.
  • A CountyCare staff member was rude.
  • Your provider or a CountyCare staff member was insensitive to your needs.

You can file your grievance on the phone by calling Member Services at 312-864-8200/855-444-1661 (toll-free)/711 (TDD/TTY). You can also file your grievance in writing via mail or fax to:

CountyCare Health Plan
P.O. Box 21153
Eagan, MN 55121
Fax: 866-200-5031

We will try to resolve your grievance right away. If we cannot, we may contact you for more information.

If you have questions or would like more information on Member Grievances, please see the Member Handbook or call Member Services.

Member Appeals

You can appeal any decision that CountyCare makes about your care. If a requested service or item cannot be approved, or if a service is reduced or stopped, you will get a Adverse Benefit Determination letter. You may appeal within 60 calendar days of the date on the letter.

If you want your services to stay the same while you appeal, you must say so when you appeal. And, you must file your appeal no later than ten (10) calendar days from the date on the Adverse Benefit Determination letter.

To have someone else act on your behalf in an appeal, complete and return the Authorized Representative form. The person listed will be accepted as your authorized representative. We are unable to speak with this person on your behalf unless this form is completed, signed, and returned to us.

You may want to appeal if CountyCare:

  • Did not approve care your provider asked for.
  • Did not pay for care your provider asked for.
  • Stopped a service that was approved before.
  • Did not arrange for timely care.

There are two ways to file an appeal:

  1. Call Member Services at 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY). If you file an appeal over the phone, you must follow it with a written signed appeal request.
  2. Mail or fax your written appeal request to:

CountyCare Health Plan
P.O. Box 21153
Eagan, MN 55121
Fax: 866-200-5031

You can get help filing an appeal by calling Member Services. For more information on Member Appeals, please see the Member Handbook (Spanish, Polish).

Program Integrity (Fraud)

County Care has a program integrity process to detect, investigate and mitigate issues that may be considered fraud, waste, abuse, mismanagement, or misconduct. CountyCare takes program integrity seriously and encourages members to report any activity that could be fraud, waste, abuse, or program mismanagement or misconduct.

Fraud is when a person gets benefits or payments to which he is not entitled. Please let us know if you think someone is committing fraud. This could be a provider or a member.

Some examples of fraud include:

  • Lying on a CountyCare or Medicaid form
  • Using someone else’s ID card
  • A provider billing for services that a member did not get

You can report any suspected fraud by calling Member Services. You can also use our Fraud and Abuse hotline at 844-509-4669. All information is private.

Abuse and Neglect

CountyCare knows that members often rely on others to help with healthcare needs. Sometimes someone who is supposed to help takes advantage of another person. This may be a provider or a family member. It is important to recognize the signs of abuse and neglect. We want CountyCare members to report abuse or neglect immediately.

What Is Neglect?

Neglect occurs when a caregiver withholds food, clothing, shelter, or medical care.

What Is Abuse?

Abuse means causing physical or mental harm. This can also be taking advantage of a person financially.

  • Physical abuse is contact that causes bodily harm. For example, being hit or stabbed.
  • Sexual abuse is any sexual behavior or contact that occurs without permission.
  • Mental abuse includes yelling, name calling or threats. Controlling behavior, embarrassment, or social isolation are also types of mental abuse.
  • Financial abuse is when someone uses someone else’s money without consent.

What Can I Do?

If you believe that you or someone else is being taken advantage of or hurt by someone, report it. All information is private.

There are many ways to report fraud, abuse or neglect:

  • CountyCare Member Services:312-864-8200/855-444-1661 (toll-free)/ 711 (TDD/TTY)
  • CountyCare Fraud and Abuse hotline: 844-509-4669
  • DHS Office of the Inspector General: 800-368-1463
  • IL Department on Aging: 866-800-1409 /888-206-1327 (TTY)
  • Senior Helpline: 800-252-8966/888-206-1327 (TTY)
  • IL Department of Public Health: 800-252-4343

See the Member Handbook (Spanish, Polish) for more information about Fraud, Abuse and Neglect.

Non-discrimination Statement

Discrimination is against the law.

CountyCare complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. CountyCare does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

CountyCare:

  • Provides free aids and services to people with disabilities to communicate effectively with us, such as:
    • Qualified sign language interpreters
    • Written information in other formats (large print, audio, accessible electronic formats, other formats)
  • Provides free language services to people whose primary language is not English, such as:
    • Qualified interpreters
    • Information written in other languages

If you need these services, please contact Member Services at CountyCare: Phone: 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY).

If you believe that CountyCare has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:

CountyCare Grievance & Appeals Coordinator
CountyCare Health Plan
P.O. Box 21153
Eagan, MN 55121
Phone: 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY
Fax: 312-548-9940
Electronically: https://countycare.valence.care/

You can file a grievance in person or by mail, fax, or via our website. If you need help filing a grievance, the CountyCare Grievance & Appeals Coordinator is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services
200 Independence Avenue,
SW Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html

English:
ATTENTION: If you speak ENGLISH, language assistance services, free of charge, are available to you. Call 312-864-8200 / 855-444-1661 (toll-free) / 711 (TTY).

Spanish:
ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 312-864-8200 / 855-444-1661 / 711 (TTY).

Polish:
UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 312-864-8200 / 855-444-1661 / 711 (TTY).

Chinese:
注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 312-864-8200 / 855-444-1661 / 711.。

Korean:
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 312-864-8200 / 855-444-1661 / 711. 번으로 전화해 주십시오.

Tagalog:
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 312-864-8200 / 855-444-1661 / 711.

Arabic
ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم 312-864-8200 / 855-444-1661 / 711 (رقم هاتف الصم والبكم: 312-864-8200 / 855-444-1661 / 711).

Russian
ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 312-864-8200 / 855-444-1661 (телетайп: 711).

Gujarati
સુચના: જો તમે ગુજરાતી બોલતા હો, તો નિ:શુલ્ક ભાષા સહાય સેવાઓ તમારા માટે ઉપલબ્ધ છે. ફોન કરો 312-864-8200 / 855-444-1661 (TTY: 711).

Urdu
خبردار: اگر آپ اردو بولتے ہیں، تو آپ کو زبان کی مدد کی خدمات مفت میں دستیاب ہیں ۔ کال 312-864-8200 / 855-444-1661 (TTY: 711).

Vietnamese
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 312-864-8200 / 855-444-1661 (TTY: 1-711).

Italian
ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 312-864-8200 / 855-444-1661 (TTY: 711).

Hindi
ध्यान दें: यदि आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं। 312-864-8200 / 855-444-1661 (TTY: 711) पर कॉल करें।

French
ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 312-864-8200 / 855-444-1661 (ATS : 711).

Greek
ΠΡΟΣΟΧΗ: Αν μιλάτε ελληνικά, στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης, οι οποίες παρέχονται δωρεάν. Καλέστε 312-864-8200 / 855-444-1661 (TTY: 711).

German
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 312-864-8200 / 855-444-1661 (TTY: 711).

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