| MAP
Patient Responsibilities
Program Overview
MCAC Medical Access Program doctors, pharmacists,
dentists, clinic workers, and many others are volunteering their
services to help you get well and stay well. As volunteers, they
are not being paid for their services to you. The Medical Access
Program (MAP) is a volunteer program, not a government program
or an insurance program.
It is your responsibility to review the
Benefits Sheet and confirm what services are donated. Medical
Access Program does not cover emergency room expenses, ambulance
or medical supply services. Our help may end at any time, for
any reason. You can be disenrolled with or without cause. Your
responsibilities under this program, the assistance available
and other conditions of the program may change at any time. We
reserve the right to verify what you have told us and to require
that you pay for any assistance that you may have received based
on inaccurate information provided by you.
General
You agree that you:
1. Will not schedule appointments with any doctors other than
the ones to which you have been referred by MAP. MCAC will schedule
all first appointments to specialist physicians.
2. Will follow your treatment plan, for example: get prescribed
medicines and take as directed.
3. Will promptly supply any information, which may be requested
by the program.
4. Will allow financial and clinical information regarding your
participation in this program to be shared with other individuals,
organizations and agencies to facilitate your health care services.
Non-identifying information may be shared for administrative purposes.
5. Will immediately contact MAP if your income changes or if you
become covered by Medicare, Medicaid, private insurance, supplementals
or other health insurance or medical benefits.
6. Will apply for Medicaid or other assistance programs either
at enrollment or within 3 business days after enrollment and complete
the process within 14 days of filing the Medicaid application.
7. Will respond to the 6 month re-enrollment questionnaire and
1 year re-enrollment procedure if you need your enrollment in
MAP to continue.
8. Will pay for any service not eligible under MAP.
Referrals
You agree to:
1. Keep each doctor’s appointment. If you miss 3 or more
appointments in 12 months without letting the doctor’s office
know at least 24 hours before your appointment, you will be dropped
from the program and cannot initiate the MCAC application process
for reenrollment for a period of 6 months following the third
missed appointment.
2. Present your Medical Care Access Coalition I.D. card each time
you see a doctor or pharmacist.
3. Call Medical Care Access Coalition or your doctor if you need
to be seen elsewhere for care.
Medications Assistance
You understand that:
1. When prescribed medication you will first ask the physician
to use samples, apply for free drug programs, and only go to the
pharmacy to fill your prescription as a last resort. MAP will
assist you in trying to obtain samples and in applying for free
drug programs.
2. It is your responsibility to reapply for free drug programs
at necessary intervals so that you can maintain a required supply
of your prescription medications. Please call the MCAC office
well in advance of running out of needed medications.
Litigation
You understand that:
1. If you are involved in a medical related lawsuit at any time
during your enrollment in the Medical Access Program, you may
be disenrolled from the Medical Access Program and may be made
responsible for the repayment of all medical treatment received
as a result of the accident, injury, or illness associated with
that lawsuit.
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