A Collection of Health Resources in Massachusetts.

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Your Rights

In addition to helping members understand their covered benefits and get the services they need, My Ombudsman provides information about member rights. 

  • As a MassHealth member or a member of a MassHealth health plan, you have certain rights. 

  • These rights exist to protect your privacy, safety, and dignity as a healthcare consumer. 

THE IMPORTANCE OF UNDERSTANDING ONE’S RIGHTS:

Knowledge is power. By understanding your member rights, you become a more empowered consumer. Understanding your member rights gives you tools to navigate the healthcare system with confidence, so you can focus on what matters most: your health. 

WHAT RIGHTS DO ALL MASSHEALTH MEMBERS HAVE?

As a MassHealth member, you have the right to:

  1. Nondiscrimination, or protection from being excluded or treated differently based on your race, color, national origin, age, disability, religion, creed, sexual orientation, or sex, including gender identity and gender stereotyping. This includes the right to get information written in languages other than English, the right to an interpreter who speaks your language, and the right to access qualified sign language interpreters, large-print materials, Braille information, or information in another format. 

  2. Ask for a copy of your health records at any time. Most providers need you to make the request in-person or in writing. If you need help with this process, contact your provider’s medical records department, or reach out to us at My Ombudsman.

  3. Have information about your health kept private. This right is protected by MassHealth policy, state law, and Federal law. You decide who can see your health information and who can’t. For example, My Ombudsman can’t access any of your records unless you give us clear permission.

  4. Get information about your health conditions and treatment options in a way that is easy to understand. This includes getting information presented in your language, information in different formats (like Braille), and getting help from someone else to understand information about your health.

  5. Take part in all decisions about your healthcare. Providers and insurance companies are required to let you know about any decisions involving your healthcare in a way that you understand. You can always disagree with decisions made by your provider or health insurer.

  6. Refuse healthcare treatment at any time, for any reason. You do not have to receive any medical care or treatment that you don’t want, even if your provider suggests it. You have the right to ask about other treatment options, find a different provider, or get no treatment at all.

  7. File a grievance or appeal. If you think MassHealth or your health plan denied you a medically necessary service or treatment, you have the right to make a formal complaint (grievance) or ask MassHealth to change its decision (appeal). My Ombudsman cannot represent you or your plan, but we can help explain the process.

  8. Choose an Authorized Representative Designation (ARD.) An ARD is a person you choose to help you sign up for MassHealth, communicate with MassHealth, and get information about your healthcare. An ARD can be a friend, a family member, a different person you trust, or someone who works for an organization. To choose someone as your ARD, fill out this form. My Ombudsman can help you fill out this form, but we cannot be your ARD.

WHAT ARE MY RIGHTS AS A MEMBER OF A SPECIFIC MASSHEALTH HEALTH PLAN?

Some MassHealth members also belong to health plans, which are required to cover the same basic benefits and services as MassHealth. If you are a MassHealth health plan member and want to learn about that plan’s member rights, a good place to start is your member handbook. If you need a copy of your member handbook, contact your health plan to request one. The handbooks are also available online at each health plan’s website. If you have questions or want help understanding your member rights, you can contact your health plan or ask My Ombudsman.

HOW DOES MY OMBUDSMAN HELP ENSURE MEMBERS CAN UNDERSTAND THEIR HEALTH PLAN BENEFITS AND RIGHTS?

When we explain information about plan benefits or rights, we are committed to making sure we do it in a language and format that members can understand.  For example, we offer support in over 165 languages (including ASL) and have staff experienced at working with people from various backgrounds. We can also provide information in electronic or large-print format, or in whatever format will best meet your needs.

WHAT DO I DO IF MY MEMBER RIGHTS, OR SOMEONE ELSE’S RIGHTS, HAVE BEEN VIOLATED?

There are multiple state offices and other legal organizations that focus on healthcare consumer rights. To find out how to contact them, visit our Resources page. You can also contact My Ombudsman to discuss your concerns. If My Ombudsman can’t resolve your concern, we will try to refer you to a place that can help.

In some situations, violations of member rights may involve abuse or neglect. If you or someone you know is being abused or neglected, please reach out to one of the organizations listed here.