Medicaid Member Rights and Responsibilities

Members have the right to:

1. You have the right to get accurate, easy-to-understand information to help you make good choices about your child’s dentists and other providers.
2. You have the right to know how your child’s dentists are paid. You have a right to know about what those payments are and how they work.
3. You have the right to know how DentaQuest decides about whether a service is covered or medically necessary. You have the right to know about the people in DentaQuest’s office who decide those things.
4. You have the right to know the names of the dentists and other providers enrolled with DentaQuest and their addresses.
5. You have the right to pick from a list of dentists that is large enough so that your child can get the right kind of care when your child needs it.
6. You have the right to take part in all the choices about your child’s dental care.
7. You have the right to speak for your child in all treatment choices.
8. You have the right to get a second opinion from another dentist enrolled with DentaQuest about what kind of treatment your child needs.
9. You have the right to be treated fairly by DentaQuest, dentists, and other providers.
10. You have the right to talk to your child’s dentists and other providers in private, and to have your child’s dental records kept private. You have the right to look over and copy your child’s dental records and to ask for changes to those records.
11. You have a right to know that dentists, hospitals, and others who care for your child can advise you about your child’s health status, medical care, and treatment. Your child’s dental health plan cannot prevent them from giving you this information, even if the care or treatment is not a covered service.
12. You have a right to know that you are not responsible for paying for covered services for your child. Dentists, hospitals, and others cannot require you to pay any other amounts for covered services.
13. You have the right not to be secluded or restrained as a punishment or to make things easier for your provider.
     

You and DentaQuest both have an interest in seeing your child’s dental health improve. You can help by assuming these responsibilities:

1. You and your child must try to follow healthy habits, such as encouraging your child to exercise, to stay away from tobacco, and to eat a healthy diet.
2. You must become involved in the dentist’s decisions about you and your child’s treatments.
3. You must work together with DentaQuest’s dentists and other providers to pick treatments for your child that you have all agreed upon.
4. If you have a disagreement with DentaQuest you must try first to resolve it using DentaQuest’s complaint process.
5. You must learn about what DentaQuest does and does not cover. You must read your Member Handbook to understand how the rules work.
6. If you make an appointment for your child, you must try to get to the dentist’s office on time. If you cannot keep the appointment, be sure to call and cancel it.
7. You must report misuse by dental and health care providers, other members, DentaQuest, or other dental or medical plans.
    

Additional Member Responsibilities while using NEMT Services

1. When requesting NEMT Services, you must provide the information requested by the person arranging or verifying your transportation.
2. You must follow all rules and regulations affecting your NEMT services.
3. You must return unused advanced funds. You must provide proof that you kept your dental appointment prior to receiving future advanced funds.
4. You must not verbally, sexually, or physically abuse or harass anyone while requesting or receiving NEMT services.
5. You must not lose bus tickets or tokens and must return any bus tickets or tokens that you do not use. You must use the bus tickets o tokens only to go to your dental appointment.
6. You must only use NEMT Services to travel to and from your dental appointments.
7. If you have arranged for an NEMT service but something changes, and you no longer need the service, you must contact the person who helped you arrange your transportation as soon as possible.
    

If you think you have been treated unfairly or discriminated against, call the U.S. Department of Health and Human Services (HHS) toll free at 1-800-368-1019. You also can view information about the HHS Office of Civil Rights online at www.hhs.gov/ocr.