Medicaid Member Rights & Responsibilities | Denver Health Medical Plan

Member Rights

Health First Colorado Administered by Elevate Medicaid Choice provides access to medical care for all its members. We do not discriminate based on your religion, race, national origin, color, ancestry, handicap, sex, sexual orientation, gender identity or age. We give care through a partnership that includes your provider, Elevate Medicaid Choice, other health care staff, and you – our member. Elevate Medicaid Choice is committed to partnering with you and your provider. As an Elevate Medicaid Choice member, you have all of the following rights:

To be provided with health care services in accordance with requirements for access, coverage and coordination of medically necessary services.
To be treated with respect and with consideration to your dignity and privacy.
To get information from your provider about all of the treatment options and alternatives for your health condition in a way that makes sense to you.
To participate in decisions regarding your health care, including the right to refuse treatment.
To get a second opinion (have some other provider review your case) at no cost to you. Elevate Medicaid Choice will arrange a second opinion with an out-of-network provider if a DHMC provider is not available.
To make an Advance Directive.
To get detailed information about Advance Directives from your provider and to be told up front if your provider cannot follow your Advance Directives because of their beliefs.
To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation. (This means that Elevate Medicaid Choice providers and staff cannot hold you against your will to punish you, get you to do something they want or get back at you for something you have done).
To get health care services from providers within the Elevate Medicaid Choice appointment standards timeframes.
To see providers who make you comfortable and who meet your cultural needs.
To use any hospital or other facility for emergency and urgent care services. Emergency and urgent care services do not require prior approval or referral.
To obtain available and accessible services under the Contract.
To get health care services outside of the Denver Health Network if you are not able to get them in the Denver Health Network (Elevate Medicaid Choice must approve non-emergency and non-urgent care services first).
To get family planning services directly from any family planning provider, in-network or out-of- network, without Elevate Medicaid Choice approval or referral.
Request a copy of your medical records, and request that they be amended or corrected.
To file a grievance, appeal or ask for a State fair hearing.
To join the Elevate Medicaid Choice Consumer Advisory Committee.
To get complete benefit information from Elevate Medicaid Choice. This information includes covered services, how to get all types of care like emergency care, detailed information about providers, and your disenrollment rights.
To use your rights above, without fear of being treated poorly by Elevate Medicaid Choice, network providers or the State Agency.

Member Responsibilities

Elevate Medicaid Choice wants to give every member outstanding care and a great experience every time they come to Denver Health. That is why we expect our members, staff and providers to treat each other with dignity and respect. As a Elevate Medicaid Choice member, you are also responsible for:

Selecting a Primary Care Physician (PCP) or Medical Home that is in the Denver Health Network.
Following all of the rules in the member handbook.
Getting an approval from your PCP before you see a Specialist (unless one is not needed).
Following the rules of the Elevate Medicaid Choice appeal and grievance process.
Calling the Denver Health Appointment Center 303-436-4949 to change your PCP.
Paying for any health care that you get without referral from your PCP (unless the services are emergency or urgent care services, or if they are “Wrap-Around” benefits).
Paying for any services that are not covered by Elevate Medicaid Choice or Health First Colorado (Colorado’s Medicaid Program).
Telling Elevate Medicaid Choice about any other insurance you have besides Health First Colorado.
Calling the Appointment Center 303-436-4949 24 hours before your appointment date if you need to cancel your appointment.
Updating your address when you move.