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Member rights and responsibilities

You have rights and responsibilities as an Aetna Better Health® of Kentucky member.

Your rights

Your rights

As a member of this plan, you have many rights you can count on. These include your right to:

 

  • Get medical care regardless of race, color, religion, sex, age, disability, sexual orientation, gender identity or nationality 

  • Be treated with respect and dignity and have your privacy protected

  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation 

  • Choose a primary care physician (PCP) 

  • Get medical care when you need it no matter where you live

  • Ask questions and get complete information about your medical condition and treatment options

  • Be told that services aren’t covered before you get them 

  • Make health care decisions, including refusing treatment

  • Ask for a second opinion about your health care

  • Have your care and medical records kept private

  • Get a copy of your health care record  

  • File a grievance or an appeal with us and ask for a state fair hearing from the Department for Medicaid Services if you have problems with your eligibility or health care

  • Get help filing a grievance or an appeal

  • Understand information about your plan

  • Get free translation services if you need them 

  • Prepare advance directives according to state laws

  • Ask for a description of the payment methods we use to pay our providers for your care

  • Know about a program or site change that affects you 30 days in advance

  • Make recommendations about our rights and responsibilities policy 

  • Receive information about an organization’s services, providers, and members’ rights and responsibilities

Your responsibilities

Your responsibilities

As an Aetna Better Health of Kentucky member, you are responsible for:

 

  • Giving accurate information so providers can take care of you and your family

  • Following your PCP’s instructions and care plans

  • Participating in your health care decisions and making healthy choices

  • Calling your PCP when you need medical care

  • Going to providers in our network

  • Showing your Aetna Better Health and your Kentucky Medicaid ID cards every time you get care

  • Bringing other health insurance cards to your appointment if you have other health insurance coverage (including Medicare) 

  • Keeping all appointments and being on time

  • Canceling an appointment if you can't get there

  • Following our policies and procedures

  • Following your doctor’s rules in their office

  • Asking your PCP questions if you do not understand something about your medical care

  • Telling the truth about yourself and your medical problems

  • Reporting suspected cases of fraud and abuse

  • Telling the Department for Community Based Services (DCBS) or the Social Security Administration (SSA) about changes to your name, address and telephone number 

  • Notifying DCBS or SSA if you have a change, like a birth, death or marriage, or if you obtain other insurance

  • Learning the difference between an emergency and needing urgent care

  • Understanding your rights and responsibilities as a member

We have responsibilities, too

We put your health first when we make health care decisions. We don’t reward our providers for denying services. And we don’t encourage our providers to reduce your care in any way. We don’t let any employee hire, promote or fire providers that may support denying benefits.

 

Call us

You can find out more about your rights and responsibilities by calling Member Services at 1-855-300-5528 (TTY: 711).

Read more here

You can find out more about your rights and responsibilities in your member handbook.