Member Rights and Responsibilities

Members should be clearly informed about their rights and responsibilities in order to make the best healthcare decisions. That includes the right to ask questions about the way HealthKeepers, Inc. conducts business as well as the responsibility to learn about their healthcare coverage.

The following member rights are defined by the Commonwealth of Virginia and appear in the Anthem HealthKeepers Plus member welcome packets and member handbook.

Member rights

Members have the right to:

  • Not be discriminated against on the basis of race, color, national origin, gender, gender identity, age or disability in its health programs and activities, and be treated consistently with their gender identity. Members with limited-English proficiency (LEP) have the right to meaningful access, including qualified interpreter services. 
  • Receive Early, Periodic, Screening, Diagnosis and Treatment (EPSDT) services; children aged 20 and under may be eligible to receive certain otherwise noncovered services under Medicaid EPSDT provisions. EPSDT covers services which are medically necessary to maintain the member’s present condition or improve or correct the condition. These benefits include, but are not limited to, services for nursing care, individualized treatments specific to developmental issues and accessing carved-out services. 
  • Choose a PCP; members have access to a full range of cost-effective healthcare providers and benefits. They may choose any PCP listed in the Anthem HealthKeepers Plus provider directory to manage their health, as long as that PCP is accepting new patients. PCPs specialize in the areas of general practice, family practice, internal medicine and pediatrics. If the selected PCP terminates his or her relationship with HealthKeepers, Inc., they will be notified via letter prior to the effective date of termination. HealthKeepers, Inc. will assign them a new PCP, but they have the right to change their PCP if they are not satisfied with the PCP assignment made. If an Anthem HealthKeepers Plus provider other than their PCP terminates his or her relationship with the Anthem HealthKeepers Plus plan, HealthKeepers, Inc. will notify all affected members prior to the effective date of the termination. 
  • Be treated with respect; as well as with recognition of their dignity and their right to privacy. HealthKeepers, Inc. abides by Code of Virginia § 32.1-127.1:03 and HIPAA (45 CFR parts 106 and 164) and has a number of procedures in place to ensure member privacy. Any medical information about members that HealthKeepers, Inc. receives, including medical records from healthcare professionals or hospitals, will be kept confidential and, except as permitted by law, will not be made available to anyone without written permission of the member. Members can review any personal information HealthKeepers, Inc. collects about them and corrections can be made at the members’ request. 
  • Receive prompt treatment and service; members should always be treated promptly, with courtesy and respect, by their healthcare providers. Likewise, when they have questions or need help with their plan benefits, they should always receive prompt and courteous service from Anthem HealthKeepers Plus employees. 
  • Know about all their treatment options and alternatives and to participate with providers in making decisions about their healthcare. Members have the right to a candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage. 
  • Participate with practitioners in making decisions about their healthcare; HealthKeepers, Inc. encourages members to discuss each treatment option/alternative with their doctor and to participate in the decision about their course of care. 
  • Refuse treatment and be told of the possible results of refusing treatments, including whether refusals may result in disenrollment with the Anthem HealthKeepers Plus plan. 
  • Voice complaints or appeals about the organization or the care it provides; Member Services staff can resolve most member concerns if they are ever dissatisfied with HealthKeepers, Inc. or the care they have received from a participating healthcare professional. 
  • File a complaint or appeal a decision; in order to remain responsive to member needs, HealthKeepers, Inc. has established both a complaint and an appeal process.
  • Request and receive information about the organization, its services, its practitioners and providers and member’s rights and responsibilities; HealthKeepers, Inc. may also periodically send members information on how to use the benefits and features of their health plan. 
  • Request and receive a copy of their medical records at any time from their provider. HealthKeepers, Inc. can also assist members in getting medical records. 
  • Request that their medical records be amended or corrected. 
  • Make recommendations regarding the organization’s member rights and responsibilities policy; being a partner in their healthcare means remaining involved in, and informed about, the decisions that affect their health. HealthKeepers, Inc. welcomes all suggestions regarding what member rights and responsibilities should be, as well as what the plan’s rights and responsibilities should be. 
  • Contact Member Services staff with any questions, concerns or suggestions. 
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation, as specified in other federal regulations on the use of restraints and seclusion. 
  • Have free exercise of their rights, and the exercise of those rights does not adversely affect the way HealthKeepers, Inc. and its providers treat them. 
  • Be provided information about advance directives as required in 42 CFR§§ 489.102 and 422.128. 
  • Make an advance directive, or living will. 
  • Be furnished healthcare services in accordance with federal regulations 42 CFR §§ 438.206 through 438.210.

Member Responsibilities

Members have the responsibility:

  • To select their PCP when they enroll, and maintain a designated PCP as long as they are an Anthem HealthKeepers Plus member. If they do not select a PCP upon enrollment or if the PCP they previously selected terminates his or her relationship with the Anthem HealthKeepers Plus plan, HealthKeepers, Inc. will select a PCP for them. 
  • Of getting to know their PCP; establishing a personal and continuous relationship with their PCP is an essential part of maintaining good health, because it allows them to become more familiar with their individual healthcare needs. 
  • To use only their PCP and in-network providers because their PCP is responsible for managing their health, they should see their PCP before receiving nonemergency services from any healthcare provider. If they need care from a specialist, their PCP will refer them to an appropriate healthcare professional. 
  • Of understanding their health problems and participating in developing mutually agreed upon treatment goals, to the degree possible; it is important that members work together with providers and their staff to be a partner in their healthcare and follow their advice and the care they recommend. 
  • Of taking the necessary steps to have their previous medical records and any updates transferred to their current doctor. 
  • To supply information (to the extent possible) that the organization and its practitioners and providers need in order to provide care; in addition, if they have any plan, they should discuss it with their provider. 
  • To follow plans and instructions for care that they have agreed to with their practitioners. 
  • To understand the medications they are taking and whether they are scheduled for follow-up visits. 
  • To keep all diagnostic or treatment appointments as scheduled; members are expected to be on time for appointments. When they cannot attend an appointment, members are expected to cancel appointments 24 hours in advance. 
  • To understand their ID card, carry it with them at all times and present the card whenever they receive covered services. 
  • To ensure only they use their ID card. 
  • To know what is considered emergency care and what is considered urgent care; members should know when to use the emergency room for care and when to seek care from their PCP. 

If a provider would like additional information regarding member rights and responsibilities, they can call Anthem HealthKeepers Plus Provider Services at 1-800-901-0020. Members with hearing or speech loss may call TTY 711.

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