Member Responsibility

As with any membership program, you have certain rights and responsibilities when you join PRIME HEALTH CHOICE, LLC.  As a member of PRIME HEALTH CHOICE, LLC your key responsibilities are:

  • Receive all of your covered benefits through the PRIME HEALTH CHOICE, LLC program.
  • Use the providers listed in the Provider Directory to obtain covered services.
  • Talk with your Care Manager about the services you need. In most cases, the services you receive from PRIME HEALTH CHOICE, LLC require the approval (or “authorization”) of your Care Coordinator before you can get care.
  • Let your Care Coordinator know if you plan to travel out of town.  She/ he will temporarily cancel the services you are receiving in your home and in your community.  In addition, if you need assistance while you are away, she/he may be able to arrange for care while you travel.
  • Get care immediately if you have an emergency.  However, please try to let us know within 24 hours, or as soon as possible, so that we can be sure that the services you receive from PRIME HEALTH CHOICE, LLC are adjusted for any changes in your health status.
  • Pay PRIME HEALTH CHOICE, LLC any Medicaid Surplus that you owe.  Your surplus amount is based on Medicaid eligibility rules and is determined by Medicaid.  You may want to contact Medicaid to discuss Medicaid eligibility rules and how your Medicaid surplus is determined.  Your Care Coordinator or Social Worker will be glad to help with this.  Just call the PRIME HEALTH CHOICE, LLC phone number at the front of this Handbook during regular business hours.
  • Call PRIME HEALTH CHOICE, LLC whenever you have a question regarding your membership or need assistance. We want to make PRIME HEALTH CHOICE, LLC the very best long term care program.  To do that, we need your help and your ideas.  We invite you to call or write us at any time.  Tell us what you like, and give us suggestions.  Our address and telephone number are listed on the back cover of this Handbook.  And, every so often we or our representatives may send you a short survey or call you on the phone to ask how you feel about PRIME HEALTH CHOICE, LLC please tell us.  Our staff considers each comment and suggestion from members and families to see how we can improve the program for everyone.  It is an easy way for you to take part in improving PRIME HEALTH CHOICE, LLC policies, providers and services.