Member's Rights & Responsibilities
Members have the right to:
- Be treated with courtesy, consideration, respect, dignity and need for privacy.
- Be provided with information about Aetna Better Health of Kansas, its policies and procedures, its services, the practitioners providing care, and members’ rights and responsibilities and to be able to communicate and be understood with the assistance of a translator if needed.
- Be able to choose a PCP within the limits of the plan network, including the right to refuse care from specific practitioners.
- Participate in decision-making regarding your health care, including the right to refuse treatment.
- Voice grievances about Aetna Better Health of Kansas or care provided and recommend changes in policies and services to plan staff, providers and outside representatives of your choice, free of restraint, interference, coercion, discrimination or reprisal by the plan or its providers.
- File appeals about the Plan action or denial of service and to be free from any form of retaliation.
- Formulate advance directives.
- Request a copy of your medical records and ask that they be amended or corrected.
- Be free to exercise your rights without Aetna Better Health of Kansas, our providers or the state treating you badly
- Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.
- Be free of hazardous procedures.
- Receive information on available treatment options or alternative courses of care in a way that you understand regardless of cost or benefit coverage, including the right to refuse treatment or medication.
- Refuse treatment and be informed of the consequences of such refusal.
- Have services provided that promote a meaningful quality of life and autonomy for you, independent living in your home and other community settings as long as medically and socially feasible, and preservation and support of your natural support systems.
- Available and accessible services when medically necessary.
- Access care 24 hours a day, seven days a week for urgent and emergency conditions. For life-threatening conditions call 911.
- Be afforded a choice of specialist among participating providers.
- Obtain a current directory of participating providers in Aetna Better Health of Kansas including addresses and telephone numbers, and a listing of providers who accept members who speak languages other than English.
- Obtain assistance and referral to providers with experience in treatment of patients with chronic disabilities.
- Be free from balance billing by providers for medically necessary services that were authorized by Aetna Better Health of Kansas.
- A second opinion.
- Prompt notification of termination or changes in benefits, series or provider network.
- Be able to request and obtain Member Handbook information at least once a year.
Members have the responsibility to:
- Use their ID cards when they go to health care appointments or get services and do not let anyone else use their card.
- Know the name of their PCP and their service coordinator if they have one.
- Know about their health care and the rules for getting care.
- Tell Aetna Better Health of Kansas and their Medicaid program when they make changes to their address, telephone number, family size and other information.
- Understand their health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible.
- Be respectful to the health care providers who are giving them care.
- Schedule their appointments, be on time, and call if they are going to be late to or miss their appointment.
- Give their health care providers all the information they need.
- Tell Aetna Better Health of Kansas about their concerns, questions or problems.
- Ask for more information if they do not understand their care or health condition.
- Follow their health care provider’s advice.
- Tell us about any other insurance they have.
- Tell us if they are applying for or get any other health care benefits.
- Bring shot records to all appointments for children under 18 years old.
- Give their doctor a copy of their living will or advance directive.
- Keep track of the cost-sharing amounts they pay.