Your Rights and Responsibilities

Your Rights as an AmeriHealth Caritas Next Member

AmeriHealth Caritas Next is committed to complying with all applicable requirements under federal and state law and regulations pertaining to member privacy and confidentiality rights.

As a member, you have the right to:

• Get information about:
• AmeriHealth Caritas Next and its health care providers
• Your rights and responsibilities
• Your benefits and services
• The cost of health care services and any required cost sharing
• Have AmeriHealth Caritas Next and its health care providers treat you with dignity and respect and recognize your right to privacy.
• Get materials or help in languages and formats other than written English, such as Braille, audio, or sign language, as indicated, at no cost to you.
• Receive help with interpretation services, as indicated, at no cost to you.
• Receive materials that are written in a manner and format that are easily understood and culturally sensitive.
• Have personal and health information and medical records kept private and confidential in accordance with all applicable requirements under federal and state law and regulations.
• Expect that AmeriHealth Caritas Next will give you a copy of its Notice of Privacy Practices without your request, and approve or deny the release of identifiable medical or personal information, except when the release is required by law.
• Request a list of disclosures of protected health information that fall outside of treatment, payment, or health care operations.
• Request and receive a copy of your medical and claims records as allowed by applicable state and federal law.
• Ask that AmeriHealth Caritas Next amend certain protected health information.
• Ask that any AmeriHealth Caritas Next communication that contains protected health information be sent to you by alternative means or to an alternative address.
• Receive health care services consistent with applicable state and federal law.
• Talk with your health care provider about:
• Treatment plans
• Information on available treatment options and alternatives, given in a way you understand
• The kinds of care you can choose to meet your medical needs, regardless of cost or benefit coverage
• Be a part of decisions about your health care, including the right to refuse treatment. Your decision to do so will not negatively affect the way AmeriHealth Caritas Next, its health care providers, or the U.S. Department of Health and Human Services (HHS) treat you.
• Make a complaint (grievance) or appeal about AmeriHealth Caritas Next or its health care providers about the care provided to you, and for you to receive an answer.
• File a fair hearing with applicable regulatory agencies if you are not satisfied with the outcome after completing the AmeriHealth Caritas Next appeals process.
• Make an advance directive.
• Be given an opportunity to provide suggestions for changes to AmeriHealth Caritas Next member rights and responsibilities.
• Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.
• Be free from discrimination prohibited by state and federal law.
• Receive treatment in the least restrictive setting.
• Fully participate in the community and to work, live, and learn to the fullest extent possible.
• Be free to exercise your rights without adverse treatment from AmeriHealth Caritas Next, its health care providers, or HHS.
• Have access to, and receive, quality health care services that are available and accessible to you in a timely manner.
• Receive health care services that are sufficient in amount, duration, or scope and provided in a culturally competent manner to meet your specific needs.

As a member, you have the responsibility to:

• Communicate, to the extent possible, information that the plan and network providers need to care for you.
• Follow the plans and instructions for care that you have agreed on with your providers; this responsibility includes consideration of the possible consequences of failure to comply with recommended treatment.
• Understand your health problems and participate in developing mutually agreed-on treatment goals to the degree possible.
• Review all benefits and membership materials carefully, and follow health plan rules.
• Ask questions to ensure understanding of the provided explanations and instructions.
• Treat others with the same respect and courtesy as you expect to receive.
• Keep scheduled appointments or give adequate notice of delay or cancellation.