HealthyBlue 2.0/HealthyBlue Advantage Member ... - CareFirst

Member’s Rights andResponsibilitiesRights of MembersCareFirst BlueChoice promotes members’ rightsby providing mechanisms to ensure:➤ Protection of confidential information;➤ Accurate and understandable informationabout benefit plans, customer service andaccessing health care services;➤ Continuity and coordination of medicaland/or mental health or substance abuse careby participating providers;➤ Professional and responsive customer service;and➤ Timely and complete resolution of customercomplaints and appeals.Members have a right to:➤ Be treated with respect and recognition oftheir dignity and right to privacy;➤ Receive information about the Health Plan,its services, its practitioners and providers, andmembers’ rights and responsibilities;➤ Participate with practitioners in decisionmaking regarding their health care;➤ Participate in a candid discussion ofappropriate or medically necessary treatmentoptions for their conditions, regardless of costor benefit coverage;➤ Make recommendations regardingthe organization’s members’ rights andresponsibilities; and➤ Voice complaints or appeals about the HealthPlan or the care provided.Responsibilities of MembersMembers have a responsibility to:➤ Provide, to the extent possible, informationthat the Health Plan and its practitioners andproviders need in order to care for them;➤ Understand their health problems andparticipate in developing mutually agreedupon treatment goals to the degree possible;➤ Follow the plans and instructions for care thatthey have agreed on with their practitioners;➤ Pay copayments or coinsurance at the time ofservice; and➤ Be on time for appointments and to notifypractitioners/providers when an appointmentmust be canceled.Eligible Individuals’ RightsStatement Wellness andHealth Promotion Services1. Eligible individuals have a right to receiveinformation about the organization,including wellness and health promotionservices provided on behalf of the employeror plan sponsors; organization staff andstaff qualifications; and any contractualrelationships.2. Eligible individuals have a right to declineparticipation or disenroll from wellness andhealth promotion services offered by theorganization.3. Eligible individuals have a right to betreated courteously and respectfully by theorganization’s staff.4. Eligible individuals have a right tocommunicate complaints to the organizationand receive instructions on how to usethe complaint process that includes theorganization’s standards of timeliness forresponding to and resolving complaints andquality issues.New Technology AssessmentTo ensure that our members have access to safe andeffective care, CareFirst BlueChoice has a formalprocess to review and make decisions regarding newdevelopments in medical technology. We evaluatenew medical technologies and the use of existingtechnologies for inclusion as a covered benefitthrough a formal review process. We refer to medicalpersonnel, governmental agencies and publishedarticles about scientific studies in this process.30 HealthyBlue Member Handbook