Consumer Rights: Women’s Health Care Services

Applies to Managed Care Organizations only.

Any woman enrolled in an MCO can self-refer, that is, make appointments without a referral from a PCP or the MCO, 2 times a year to any ob/gyn in the MCO’s network, for routine women’s health care. In addition, an enrollee can self-refer for:

  • Any ob/gyn care related to pregnancy
  • Preventive and primary ob/gyn services to deal with a health problem found during an ob/gyn visit.
  • Treatment of an acute gynecological condition.

The plan may not charge you any more for these services than would be normally charged if the plan made the referral.

For women in Medicaid MCOs:

Your MCO must let you know that at no additional cost to you, you have the same rights as all female consumers in MCOs, plus you can go to any women’s health care provider you choose, even if that provider is outside the plan’s network, for:

  • All types of birth control
  • Sterilization
  • Testing and treatment for sexually transmitted diseases( STDs)
  • Testing for women’s health problems including anemia, cervical cancer, hypertension, breast disease, pregnancy and pelvic problems
  • Abortions
  • Education and counseling related to the list above
  • HIV testing; pre-test and post-test counseling when it is part of a regular women’s health services visit

If your MCO cannot provide you with a woman’s health service, they must tell you where you can go to get this service at no extra cost to you.