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Member Rights and Responsibilities

//Member Rights and Responsibilities
Member Rights and Responsibilities2018-06-26T13:25:49+00:00

Rights and Responsibilities

GOBHI is committed to treating you in a manner that recognizes and respects your rights. Click on the links below to find out what your rights and responsibilities are.

Your rights:

  • To be treated with dignity, respect and recognition;
  • To get services and supports that fit your culture and language needs;
  • To ask for services as close to home as possible, and in a non-traditional setting that is easier for you to use;
  • To be treated in an integrated setting and under the least restrictive conditions;
  • To have a consistent and stable relationship with a care team that is responsible for your comprehensive care management;
  • To have a friend, or helper come to your appointments, and an interpreter if you want one;
  • To receive prior notice of transfer, unless the reason for the transfer could pose a threat to health and safety;
  • To receive medication specific to your clinical needs;
  • To be free from abuse or neglect and to report any incident of abuse or neglect;
  • To be free from any form of restraint or seclusion used as means of coercion, discipline, convenience, or retaliation, CFR 438.100;
  • To have religious freedom;
  • To refuse to take part in experiments;
  • To get mental health services and help with addiction to cigarettes, alcohol and drugs without a referral;
  • To help us assign you to a mental health provider and to change that provider for a good reason;
  • To get covered preventative services;
  • To be given information about your illness
  • To get a referral to see a specialist if you need it;
  • To get a second opinion if you need it;
  • To have access to Peer Delivered Services;
  • To get care when you need it, any time of day or night, including weekends and holidays;
  • To get written notices before a denial of, or change in, a benefit or service level is made, unless such notice is not required by federal or state regulations;
  • To say in writing that Member understand and approve before the start of services, except in a medical emergency or as otherwise permitted by law. Minor children may give informed consent to services in the following circumstances:
    • Under age 18 and lawfully married;
    • Age 16 or older and legally an adult by the court; or
    • Age 14 or older for outpatient services only. For purposes of informed consent, outpatient services does not include service provided in residential programs or in day or partial hospitalization programs;
  • To get information about your condition and GOBHI covered and non-covered treatment options to allow an informed decision about proposed treatment(s);
  • To open discussion of treatment options and alternatives regardless of cost or coverage;
  • To be told about your options for care and to make a decision;
  • To help make decisions with your provider about your health care, including refusing treatment, except for court ordered services, and be told the consequences of that decision;
  • To work together with your provider in pursing your goals for recovery;
  • To make a declaration for mental health treatment, when legally and adult;
  • To write down your treatment wishes;
  • To confidentiality, and the right to consent to disclosure in accordance with ORS 107.154, 179.505, 179.507, 192.515, 192.507, 42 CFR Part 2 and 45 CFR Part 205.50;
  • To have your right to privacy respected;
  • To limit who can see your health records;
  • To see and get a copy of your health records, unless your doctor thinks it would be bad for the you;
  • To have adequate notice of Authority privacy practices;
  • To have a clinical record kept about your condition, services received, and referrals made;
  • To have your records given to another provider with your approval;
  • To get information about GOBHI, its services, its practitioners and providers and your rights and responsibilities;
  • To complain about different treatment and discrimination;
  • To make a complaint or appeal about GOBHI or one of our providers and get a timely response without a bad reaction from your plan or provider;
  • To get a Notice of Action letter if you are denied a service or there is a change in service level;
  • To get information and help to appeal denials and ask for a hearing;
  • To be informed at the state of service, and periodically thereafter, of the rights guaranteed here;
  • To be given handbooks, letters and notices that you can understand and have explained if needed;
  • To make recommendations about GOBHI’s member rights and responsibilities policy;
  • To get interpreter and translation services at no cost to you, if needed;
  • To ask Oregon Health Plan Member Services at 800-273-0557 for help with problems, or the Oregon
  • Health Authority Ombudsperson at 503- 947-2346 or toll free 877-642-0450, TTY 711;
  • To receive oversight, care coordination, and transition and planning management from GOBHI;
  • To receive assistance in navigating the health care delivery system and in accessing community and social support services resources;
  • To exercise all rights set forth in ORS 109.610 through 109.697 if the individual is a child, as defined by these rules;
  • To exercise all rights set forth in ORS 426.385 if the individual is committed to the Authority; and
  • To exercise all rights described here without any form of reprisal or punishment.

Your Responsibilities:

  • To choose or help GOBHI assign you to a mental health provider that you can work with and tell them all about your health;
  • To treat your providers and their staff with respect;
  • To get yearly check-ups, wellness visits and other services to prevent illness and keep you healthy;
  • To get mental health services from your assigned provider except in an emergency;
  • To get referral to a specialist before seeking care from a specialist unless self-referral to the specialist is allowed;
  • To be on time for appointments and to call in advance if you expect to be late or unable to keep the appointment;
  • To use urgent and emergency services when needed and to tell your provider of any mental health emergency within 3 days;
  • To ask questions about conditions, treatments and other issues related to your care that you don’t understand;
  • To use information to make informed decision about treatment before it is given;
  • To help your provider come up with a treatment plan and treatment goals you will follow;
  • To work together with your provider and follow plans, instructions for care and goals for recovery;
  • To give accurate information for the clinical record;
  • To help your provider get your clinical records from other providers which may include signing an authorization for release of information;
  • To bring your medical ID cards to appointments, tell the receptionist that you have OHP and any other health insurance, and tell them if you were hurt in an accident;
  • To pay for services not covered under your OHP benefit package if sign an ‘Agreement to Pay’ form before you get the services;
  • To pay the monthly Medicare premium on time if required;
  • To assist GOBHI, OHA, and DHS in pursing any third party resources available and to reimburse GOBHI and/or DHS the amount of benefits it paid for an injury from any recovery received from that injury;
  • To call OHP Central at 800-699-9075 when you move, have a new phone number, are pregnant or no longer pregnant, or when family members move in or out of the household;
  • To report any other insurance you have, and changes to your insurance at www.ReportTPL.org; and
  • To bring an issue, complaint, or grievance to the attention of GOBHI and/or OHA

If you would like paper copies of our Members’ Rights and Responsibilities Statement, please contact Member Services at 1-800-493-0040.