What Are My Rights?

As a plan member, you have certain rights that protect the quality of care you receive from your health plan or long term care plan.  You also have certain responsibilities. If you are joining a Long Term Care Plan, see a complete list of your rights and responsibilities. Read below to learn about your rights as a health plan member. 

Health Plan Members

Health Plan Members have certain rights, such as the right to:

• A choice of Primary Care Providers (PCPs)
• An appointment within 24 hours for urgent care and within 48 to 72 hours for routine care
• Receiving a second opinion about certain medical conditions from another provider in your plan
• Have all information about your health care kept confidential  
• Complain about your services to your health plan, the State Department of Health or New York Medicaid Choice
• Ask for a fair hearing if your plan has denied, stopped or reduced treatment or services you think you should get. In a fair hearing, the Medicaid Program will listen to your case and make a decision. To learn more about fair hearings, call New York Medicaid Choice.

You also have certain responsibilities, such as:

• Informing your health plan of any problems you may be having with your doctor or services.
• Receiving your health care services from your health plan’s providers
• Informing your health plan about any emergency room services from a hospital outside your health plan.