Member Rights and Responsibilities
Members should be clearly informed about their rights and responsibilities so they can make the best health care decisions. Members also have the right to ask questions about the way we conduct business, as well as the responsibility to learn about their health care plan coverage.
The following member rights and responsibilities are defined by the state of Wisconsin and appear in the member handbook.
Anthem Blue Cross and Blue Shield (Anthem) honors civil rights and provides covered services to all eligible members regardless of:
- Marital status
- National origin
- Gender identity
- Sexual orientation
- Military participation
- Arrest or conviction record
All medically necessary covered services are offered to all members. All services are given in the same way to all members. All persons or groups who work with Anthem, or who refer or suggest services to members, shall do so in the same way for all members. Translation or interpretation services are offered free of charge for those members who need assistance.
Members have the right to:
- Ask for an interpreter and have one provided during any BadgerCare Plus and/or Medicaid SSI covered service.
- Receive any information from the HMO provided in another language or another format.
- Receive health care services as provided for in federal and state law. All covered services must be available and accessible. When medically appropriate, services must be available 24/7.
- Receive information about the organization, its services, its practitioners, and providers and member rights and responsibilities.
- Receive information about treatment options and alternatives, including the right to request a second opinion. If an appropriately qualified network provider is not available, second opinion services from an out-of-network provider will be reimbursed at no charge to the member.
- Make decisions about his or her health care, including refusing treatment.
- Have a candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage.
- Be treated with respect and recognition of dignity and their right to privacy.
- Voice complaints or appeals about the organization or the care it provides.
- Make recommendations regarding the organization’s member rights and responsibilities policy.
- Be free from any form of restraint or seclusion used as means of force, control, convenience, or retaliation.
- Request copies of their medical records from their providers.
Members have the responsibility to:
- Show their ForwardHealth ID card each time they receive medical care.
- Make or change appointments.
- Get to appointments on time.
- Call their PCP if they cannot make it to their appointment or if they will not be on time.
- Use the emergency room only for true emergencies.
- Pay for any services they ask for that are not covered by BadgerCare Plus or Medicaid SSI.
- Treat their PCP and other health care providers with respect.
- Tell us, their PCP and their other health care providers what they need to know to treat them.
- Do the things that keep them from getting sick.
- Follow the treatment plans members, their PCP, and their other healthcare providers agree on.
- Understand their health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible.
- Tell us if they:
- Change their phone number.
- Have a change in the number of people in their household.
- Have other insurance.
- Become pregnant.