Rights and Responsibilities

Getting mental health and substance use disorder services is a private matter. We respect a member’s right to privacy. A member has, at the very least, the rights and responsibilities listed below:

Member’s rights:

To be treated with respect, recognizing your dignity and need for privacy, by Magellan staff and network providers.
To get information that you can easily locate and understand about Magellan, its services, and the providers that treat you when you need it.
To pick any Magellan network provider that you want to treat you. You may change providers if you are unhappy.
To get emergency services when you need them from any provider without Magellan’s approval.
To get information that you can easily understand from your providers and be able to talk to them about your treatment options, without any interference from Magellan.
To make decisions about your treatment. If you cannot make treatment decisions by yourself, you have the right to have someone else help you make decisions or make decisions for you. You may refuse treatment or services unless you are required to get involuntary treatment under the Mental Health Procedures Act.
To talk with providers in confidence and to have your information and records kept confidential.
To see and get a copy of your medical records and to ask for changes or corrections to your records.
To ask for a second opinion.
To file a Grievance if you disagree with Magellan’s decision that a service is not medically necessary for you.
To file a Complaint if you are unhappy about the care or treatment you have received.
To ask for a Department of Human Services Fair Hearing.
Be free from any form of restraint or seclusion used to force you to do something, to discipline you, to make it easier for the provider, or to punish you.
To get information about services that Magellan or a provider does not cover because of moral or religious objections and about how to get those services.
To exercise your rights without it negatively affecting the way the Department of Human Services, Magellan, or network providers treat you.
To request case files prior to any proceedings. There’s no cost to file.
To receive a list of advocacy organizations that can assist you.

Members need to work with their providers of behavioral health services. Magellan needs a member’s help so that they get the services and supports they need.

Member’s responsibilities:

Provide, to the extent you can, information needed by their providers.
Tell their provider the medicines they are taking. Include over-the-counter medicines, vitamins, and natural remedies.
Be involved in decisions about their health care and treatment.
Work with their providers to create and carry out their treatment plans.
Tell their providers what they want and need.
Take their medications as prescribed and tell their provider if there is a problem.
Keep their appointments.
Learn about Magellan coverage, including all covered and non-covered benefits and limits.
Use only network providers unless Magellan approves an out-of-network provider.
Respect other patients, provider staff and provider workers.
Report fraud and abuse to the Department of Human Services Fraud and Abuse Reporting Hotline.

If a member has any questions about program services, please call your county’s Member Services line:

Bucks County 877-769-9784
Cambria County 800-424-0485
Lehigh County 866-238-2311
Montgomery County 877-769-9782
Northampton County 866-238-2312