Member rights and responsibilities

Wellpoint Iowa, Inc. members enrolled in the Medicaid or Medicare Advantage plans have rights and responsibilities, and our Member Services representatives serve as their advocates.

Iowa Health Link and Hawki

Members should be clearly informed about their rights and responsibilities so they can make the best health care decisions. Members also have the right to ask questions about the way we conduct business, as well as the responsibility to learn about their health care plan coverage.

Member rights and responsibilities are defined by the state of Iowa and appear in the Member Handbook.

Wellpoint honors civil rights and provides covered services to all eligible members, regardless of the following:

  • Age
  • Color
  • Disability
  • Marital status
  • National origin
  • Race
  • Religion
  • Gender
  • Gender identity
  • Sexual orientation
  • Taking part in the military
  • Arrest or conviction record

All medically necessary covered services are offered to all members. All services are given in the same way to all members. All persons or groups who work with Wellpoint, or who refer or suggest services to members, shall do so in the same way for all members. Translation or interpretation services are offered free of charge for those members who need assistance.

Our Member Rights and Responsibilities statement specifies that members have: 

  • A right to receive information about the organization, its services, its practitioners, its providers, and member rights and responsibilities
  • A right to be
  • A right to privacy
  • A right to a candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage
  • A right to voice complaints or appeals about the organization or the care it provides
  • A right to make recommendations regarding the organization’s member rights and responsibilities policy
  • A responsibility to understand their health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible
  • A right to ask for an oral interpreter and have an interpreter given to them during any Iowa Health Link covered service
  • A right to get the information given in the Member Handbook in another language or format
  • A right to get health care services as given by federal and state law. All covered services must be offered and accessible. When medically needed, services must be offered 24/7.
  • A right to get details about treatment options, such as the right to ask for a second opinion
  • A right to make decisions about their health care
  • A right to be treated with dignity and respect
  • A right to be free from any form of restraint or seclusion used as means of force, control, convenience or retaliation

Wellpoint members have the responsibility to:

  • Show their Iowa Health Link ID card each time they receive medical care
  • Make or change appointments
  • Get to appointments on time
  • Call their PCP if they cannot make it to their appointment or if they will not be on time
  • Use the emergency room only for true emergencies
  • Pay for any services they ask for that are not covered by Iowa Health Link
  • Treat their PCP and other health care providers with respect
  • Tell us, their PCP and their other health care providers what they need to know to treat them
  • Do the things that keep them from getting sick
  • Follow the treatment plans members, their PCP and their other health care providers agree on
  • Tell us and their county/tribal economic support caseworker if:
    • They move
    • They change their phone number
    • The number of people in their household changes
    • They have other insurance
    • They become pregnant

Wellpoint Dual Coordination (HMO D-SNP)

Providers are required to adhere to CMS and the requirements of Wellpoint concerning issuing letters and notices. Wellpoint members have the right to timely quality care and treatment with dignity and respect. Each member receives a copy of the Explanation of Coverage, which outlines the member’s rights and responsibilities. Providers must respect the rights of all Wellpoint members.

  • Be treated with dignity, respect and fairness at all times
  • Receive information about the health plan, services, practitioners, providers and member rights and responsibilities
  • Receive information in a way that works for them (in languages other than English spoken in the plan service area, in Braille, large print or other alternate formats)
  • Ensure the privacy of their medical records and personal health information
  • Choose a plan provider
  • Receive care from a women’s health care provider
  • Have timely access to their providers and to receive services from specialists when appropriate
  • Obtain information from providers and be advised about all medically appropriate or necessary treatment options available for their condition, regardless of cost or benefit coverage
  • Participate fully in decisions about their health care and be informed about any risks involved in their care
  • Refuse treatment, leave a hospital or medical facility, or stop taking medications; the member must accept responsibility and the consequences of his or her decision
  • Complete an advance directive (living will or power of attorney) to help them with decisions related to their health care if they are unable
  • Voice complaints or appeals about the health plan or the care provided
  • Make recommendations regarding the health plan’s member rights and responsibilities policy
  • Receive information about the appeals and grievances members have filed against Wellpoint in the past
  • Receive information about the Medicare Advantage plan, plan providers, drugs, health care coverage and costs, including an explanation about any bills received for services or drugs not covered
  • Request information regarding provider compensation by Wellpoint
  • Receive a written or binding advance-coverage determination for health care services, even if the care is requested from a nonparticipating provider
  • Be familiar with their coverage and the rules they must follow to obtain health care
  • Notify Wellpoint if they have additional health insurance coverage
  • Notify providers when seeking care that they are Medicare members and present their Wellpoint member ID cards
  • Provide the health plan, doctors and practitioners with accurate information to render care and follow the treatment plans and instructions they agreed to with the provider
  • Understand their health problems and participate in identifying mutually agreed-upon treatment goals to the extent possible
  • Treat their provider, their provider’s staff and Wellpoint employees with respect and dignity
  • Not be disruptive in the provider’s office
  • Pay their copay for covered services
  • Notify Wellpoint if they have questions, concerns, problems or suggestions. (Members may call Member Services at the DSU at 1-866-805-4589 and TTY users should call 1-800-855-2880.)

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