Member rights and responsibilities

Our members have rights and responsibilities. Our Member Services representatives serve as their advocates.

Members have the right to:

Privacy:

• Be treated with respect and with due consideration for their dignity and privacy
• Expect that we will treat their records, including medical, personal information, and communications, confidentially
• Request and receive a copy of their medical records at no cost to the member and request that the records be amended or corrected
• Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation as specified in federal regulations

Take part in decisions regarding their healthcare:

• Receive information on available treatment options and alternatives, presented in a manner appropriate to the member’s condition and ability to understand
• Engage in candid discussions of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage
• Receive the appropriate services that are not denied or reduced solely because of medical condition
• Refuse healthcare (to the extent of the law) and understand the consequences
• Decide ahead of time the care they want if they become sick, injured, or seriously ill by making a living will
• Be able to make decisions about their children’s healthcare if members are younger than age 18 and married, pregnant, or have children

Grievances, appeals, and fair hearings:

• Pursue resolution of grievances and appeals about the health plan or care provided
• Freely exercise filing a grievance or an appeal without adversely affecting the way they are treated
• Continue to receive benefits pending the outcome of an appeal or a fair hearing under certain circumstances

Anthem Blue Cross and Blue Shield (Anthem) information:

• Be treated with respect and with due consideration for their dignity and privacy
• Expect that we will treat their records, including medical, personal information, and communications, confidentially
• Request and receive a copy of their medical records at no cost to the member and request that the records be amended or corrected
• Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation as specified in federal regulations

Take part in decisions regarding their healthcare:

• Receive information on available treatment options and alternatives, presented in a manner appropriate to the member’s condition and ability to understand
• Engage in candid discussions of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage
• Receive the appropriate services that are not denied or reduced solely because of medical condition
• Refuse healthcare (to the extent of the law) and understand the consequences
• Decide ahead of time the care they want if they become sick, injured, or seriously ill by making a living will
• Be able to make decisions about their children’s healthcare if members are younger than age 18 and married, pregnant, or have children

Grievances, appeals, and fair hearings:

• Pursue resolution of grievances and appeals about the health plan or care provided
• Freely exercise filing a grievance or an appeal without adversely affecting the way they are treated
• Continue to receive benefits pending the outcome of an appeal or a fair hearing under certain circumstances

Anthem Blue Cross and Blue Shield (Anthem) information:

• Receive the necessary information to be an Anthem member in a manner and format they can understand easily
• Receive a current member handbook and a provider directory
• Receive a copy of the member handbook and/or provider directory by request by calling Member Services at 844-912-1226
• Receive assistance from Anthem in understanding the requirements and benefits of the plan
• Receive notice of any significant changes in the benefit package at least 30 days before the intended effective date of the change
• Make recommendations about our rights and responsibilities policies
• Know how we pay our providers

Medical care:

• Choose their PCPs from our network of providers
• Choose any Anthem network specialist after getting a referral from their PCPs, if appropriate
• Be referred to healthcare providers for ongoing treatment of chronic disabilities
• Have access to their PCPs or backups 24 hours a day, 365 days a year for urgent or emergency care
• Get care right away from any hospital when their symptoms meet the definition of an emergency medical condition
• Get post-stabilization services following an emergency medical condition in certain circumstances
• Be free from discrimination and receive covered services without regard to race, color, creed, gender, religion, age, national origin ancestry, marital status, sexual preference, health status, income status, program membership, or physical or behavioral disability, except where medically indicated