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Member Rights and Responsibilities

Member Rights

As a member you have certain rights. Western Sky Community Care wants to always respect your rights. We expect our providers to respect your rights.

  • Be treated with respect and consideration.
  • Receive information on all available treatment options.
  • Have access to creating and using an Advance Directive.
  • Be able to receive Covered Services in a fair manner.
  • Be able to make decisions regarding his or her health care, including the right to refuse treatment.
  • Be free from any form of restraint or seclusion as stated in federal regulations.
  • Have access to his or her medical records and be able to request corrections.
  • Be able to choose a Representative to help with making care decisions.
  • Be able to provide informed consent.
  • Be able to express Grievances about the care provided by Western Sky Community Care.
  • Be able to choose from available Contract Providers that abide by Western Sky Community Care’s prior authorization requirements.
  • Be able to receive information about Covered Services, Contract Providers and how to access them.
  • Be able to request copayment totals paid. If there is a disagreement about the totals, members are able to appeal this information.
  • Be free from harassment by Western Sky Community Care or its Contract Providers.
  • Be able to take part in understanding physical and Behavioral Health problems and setting treatment goals.
  • Be able to make recommendations regarding Western Sky Community Care’s member rights and responsibilities.
  • Be able to exercise rights and doing so will not affect the way Western Sky Community Care or Western Sky Community Care providers treat them.

Member Responsibilities

As a member you have certain responsibilities. Treatment can work better if you do these things. Your responsibilities are:

  • Notify New Mexico Medicaid if:
    • Your family size changes
    • You move out of the state or have other address changes
    • You get or have health coverage under another policy, other third party, or there are changes to that coverage
  • Work on improving your own health
  • Tell Western Sky Community Care when you go to the emergency room.
  • Talk to your provider about preauthorization of services they recommend
  • Be aware of cost-sharing responsibilities. Make payments that you are responsible for.
  • Inform Western Sky Community Care if your member ID card is lost or stolen
  • Show your Western Sky Community Care member ID card when getting health care services
  • Know Western Sky Community Care procedures, coverage rules and restrictions the best that you can
  • Contact Western Sky Community Care when you need information or have questions
  • Give providers and Western Sky Community Care accurate and complete medical information
  • Follow prescribed treatment. Or tell your provider the reason(s) treatment cannot be followed as soon as possible.
  • Ask your providers questions to help you understand treatment. Learn about the possible risks, benefits, and costs of treatment alternatives. Make care decisions after you have thought about all of these things.
  • Be actively involved in your treatment. Understand your health problems and be a part of making treatment goals with your provider as much as you can.
  • Follow the grievance process if you have concerns about your care