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As a member of this plan, you have many rights that you can count on. These include your right:
- To be treated fairly and with respect, including your right to privacy
- To be treated with dignity and to not be discriminated against, for any reason
- To have your medical records and discussions with your health care providers kept confidential
You have the right to choose the health plan that is best for you and to:
- Be given clear information about the plan and its services, including what the plan covers
- Be able to choose your primary care provider (PCP), or main doctor, as long as they are in the Aetna® network
- Be able to change your PCP or your health plan, and know how to make that change
- Know that you are not responsible for paying for any covered services
You have the right to play an active part in your health care. This includes:
- Working as a team with your PCP to make decisions about your health
- Being able to ask questions about anything you don’t understand, and to get answers to your questions
- Being able to say yes or no to the care or treatment your PCP recommends
- Knowing that your providers can give you information about your health status and possible treatments, even if they are not covered
- Knowing why care or services were denied
You have the right to make a complaint or file an appeal and to get a timely response. This includes the right to:
- Make a complaint to your health plan or to the state Medicaid program about your health care, your provider or your health plan
- Use the plan’s appeal process and be told how to use it
- Ask for a fair hearing from the state Medicaid program and get information about how that process works
You have the right to health care that does not have any barriers. This includes:
- Being able to speak to a medical professional by phone 24 hours a day, 7 days a week
- Having access to emergency or urgent care when needed
- Having an interpreter who speaks your language with you at doctor visits or when talking to your health plan
- Being able to get in and out of your provider’s office, if you have a condition that affects your mobility
- Having information that explains your health plan rules, including what is covered and how to get services
You have the right to not be restrained or isolated when it is for someone else’s convenience, or is meant to force you to do something you do not want to do, or is to punish you.
As an Aetna Better Health® of Illinois member, you are responsible for:
Treating your doctor and the office staff with courtesy and respect.
Carrying your Aetna Better Health ID card with you when you go to your doctor appointments and to the pharmacy to pick up your prescriptions.
Keeping your appointments and be on time for them.
If you cannot keep your appointments cancel them in advance.
Following the instructions and treatment plan you get from your doctor.
Telling Aetna Better Health and your caseworker if your address or phone number changes.
Reading your member handbook so you know what services are covered and if there are any special rules.
- Learning and understanding your rights under the Medicaid program
- Asking questions if you do not understand your rights
- Learning what choices of health plans are available in your area
- Reading your member handbook and asking us questions if you don’t understand something about your health plan
You must follow the health plan’s and Medicaid’s rules and policies. That includes the responsibility to:
- Choose your health plan and a PCP quickly
- Keep your scheduled appointments
- Cancel appointments in advance when you cannot keep them
- Always contact your PCP first for nonemergency medical needs
- Be sure you have approval from your PCP before going to a specialist
- Understand when you should and should not go to the emergency room (ER)
- Follow your health plan’s and Medicaid’s rules if you make any changes to your health plan or PCP
You must share information about your health with your PCP and learn about service and treatment options. That means you have to:
- Tell your PCP about your health
- Talk to your providers about your health care needs and ask questions about the different ways your health care problems can be treated
- Help your providers get your medical records
You must be involved in decisions about your service and treatment options, make personal choices, and take action to keep yourself healthy. That includes the responsibility to:
- Work as a team with your providers in deciding what health care is best for you
- Understand how the things you do can affect your health
- Do the best you can to stay healthy
- Treat providers and staff with respect
- Talk to your provider about all of your medications
If you think you have been treated unfairly or discriminated against, call the U.S. Department of Health and Human Services (HHS) toll-free at 1-800-368-1019. Or you can visit HHS.gov/ocr, the HHS Office of Civil Rights website.