Member Rights & Responsibilities

As a member of InterCommunity Health Network CCO (IHN-CCO) and Oregon Health Plan (OHP), you have many rights. These include choosing your own provider and making a complaint to us. Here is a full list of what you can count on from IHN-CCO:

Access

• Choose an in-network primary care provider (PCP) when you first enroll and change your PCP at other times.
• Learn about CCOs and the health care system.
• Get behavioral health and family planning services without a referral or prior approval.
• Ask for services as close to home as possible, and in a non-traditional setting that is easier for you to use. Get services within 30 miles in a city area or 60 miles outside a city.
• Get a sexual abuse exam, if needed, without prior approval and you may self-refer.
• Get emergency care, any time of day or night (including weekends and holidays) with no prior approval required.
  • Get emergency medical care as soon as possible.
  • Get urgent care within 72 hours (three days).
  • Get well care (preventive care) within four weeks or as required by care coordination rules.
  • Get emergency dental care within 24 hours.
  • Get urgent dental care within one week or as needed.
  • Get urgent behavioral health care within 24 hours.
• For pregnant members, get care in the following timelines:
  • Get emergency dental care within 24 hours.
  • Get urgent dental care within one or two weeks, as needed.
• Get a referral to specialists for covered services that are need based on your health.
• See some specialists without a referral.
• Get help to use the healthcare system and get resources you need. This could include:
  • Certified or qualified health care interpreters.
  • Certified traditional health workers.
  • Community health workers.
  • Peer wellness specialists.
  • Doulas.
  • Personal health navigators.
• Get some health services on your own if you are younger than 18. OHP has a booklet called “Understanding Minor Consent and Confidentiality in Health Care in Oregon.” This booklet tells you the types of services minors can get on their own. It also tells you how minors’ health care information may be shared. Find this booklet online.
• Get a ride to covered services, at no cost.
• Share information with IHN-CCO electronically. You can choose to do this or not. 

Care

• Actively help develop your treatment plan or have family involved in your treatment plan.
• Get information about OHP-covered and non-covered treatment options for your condition.
• Agree to or refuse treatment (except for court-ordered services) and be told how that will affect you.
• Get the tests you need to find out what condition you have.
• Get care coordination, community-based care and help with care transition.
• Get care in a language and culture that aims to reduce the need for hospital or nursing home visits. 
• Have steady and stable contact with a care team that is in charge of your complete care management.
• Get covered services that help you stay healthy.
• Have a medical chart kept up to date by your doctor.
• See and get a copy of your medical chart, unless there is a legal reason that does not allow it. You may ask to change or correct what is in your chart.
• Have your medical chart sent to another doctor.
• Have an advance directive or power of attorney and have your doctors follow it.
• Get a letter if you are denied a service or there is a change in service. You may not get a letter if the law does not require it.
• Be told ahead of time if your visit is not going to happen.
• Get covered services without owing copays.
• Get a second opinion from a doctor in our network. If you need a doctor outside our network, we can help you find one. You can get a second opinion at no cost to you.
• Get your doctor’s opinion on treatment(s) available to you.

Support

• Have a friend, family member, or helper come to your visits.
• Have a helper that will coordinate your care in the best location for you.
• Ask us how to connect to people who can support your overall health and wellbeing.
• Ask for a hearing with the state if you do not agree with our appeal answer.
• Get an interpreter approved by the state, at no cost to you.
• Get person-centered care and services that give you choice, independence and dignity. 
• Exercise your member rights without any negative effects. 
• Get care coordination, community-based care and help with care transitions in a way that works with your language and culture to reduce the need for the hospital or nursing facility visits.
• Share your concerns with the OHP ombudsperson. They can help advocate for you. The OHP ombudsperson can be reached at 877-642-0540 (TTY 711). 

Nondiscrimination

• Be treated with dignity and respect.
• Be treated by your doctors the same as they treat all their patients.
• Get handbooks and letters that you can understand.
• Get services and support that fit your culture and language needs. This includes auxiliary aids and services.
• Have the same access to care as all members, no matter your age or sex.
• Complain or appeal and get a response from us without a bad reaction from your plan or provider.
• Be free from getting restrained or confined unless allowable or needed.
• To file a complaint or for more information about your rights, please review our Nondiscrimination Notice.

Being an IHN-CCO member also means you have responsibilities to us. To help us serve you best, you agree to the following:

Work With Your Care Team

• Find a doctor or other provider you can work with and tell them  about your health.
• Treat all members of your health care team and their staff with the same respect you want.
• Be on time for your visits.
• Call your doctor’s office at least one day before your visit if you cannot make it.
• Have yearly check-ups, wellness visits and other services to prevent illness and keep you healthy.
• Go to your PCP for all your healthcare needs, unless it is an emergency.
• Contact your doctor before going to urgent care or the emergency room, unless your condition is life threatening.
• Be honest with your doctor so your medical record is correct.
• Help your doctor get medical records from other doctors. You may need to sign a paper to give approval.
• Ask questions when you do not understand.
• Use your medical care team resources to make informed choices about your care.
• Help your doctor create a care plan.
• Follow the treatment plan you agreed to with your medical care team.
• Tell your doctor’s office you have IHN-CCO and show them your ID card if they ask for it.
• Pay for services you agree to get that are not covered by IHN-CCO.

Inform

• Call OHP Customer Service at 800-699-9075 (TTY 711) when:
  • You or family member moves in or out of your house.
  • You change your phone number.
  • You become pregnant, are no longer pregnant or have your baby.
  • You need to report any other health insurance (or report at reporttpl.org).
• Provide IHN-CCO facts about other sources who are paying for your care. Pay back IHN-CCO for any bills we paid if you get a medical settlement.
• Tell IHN-CCO if you have a complaint or grievance.