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Rights and responsibilities

As an OhioRISE specialized behavioral healthcare member, you have rights and responsibilities in your healthcare. If the member is a child, the child’s rights are represented by the child’s parents or legal guardian. If you need help understanding your rights and responsibilities, please call Member Services at 1-833-711-0773 (TTY: 711), 24 hours a day, 7 days a week. The call is free.

Your rights

  • To receive all services that our plan must provide.
  • To be treated with respect and with regard for your dignity and privacy.
  • To be sure that your medical record information will be kept private.
  • To be given information about your health. This information also may be available to someone who you have legally approved to have the information or who you have said should be reached in an emergency when it is not in the best interest of your health to give it to you.
  • To be able to take part in decisions about your healthcare unless it is not in your best interest.
  • To get information on any medical care treatment, given in a way that you can understand.
  • To be sure others cannot hear or see you when you are getting medical care.
  • To be free from any form of restraint or seclusion used as a means of force, discipline, ease or revenge as specified in federal regulations.
  • To ask for, and get, a copy of your medical records, and to be able to ask that the record be changed/corrected if needed.
  • To be able to say yes or no to having any information about you given out unless we have to by law.
  • To be able to say no to treatment or therapy.  If you say no, the doctor or our plan must talk to you about what could happen and must put a note in your medical record about it.
  • To be able to file an appeal, a grievance (complaint) or request a state hearing.
  • To be able to get all our written member information from our plan:

       

    • At no cost to you.
    • In the prevalent non-English language of members in our service area.
    • In other ways, to help with the special needs of members who may have trouble reading the information for any reason.
  • To be able to get help free of charge from our plan and its providers if you do not speak English or need help in understanding information.
  • To be able to get help with sign language if you are hearing impaired.
  • To be told if the healthcare provider is a student and to be able to refuse his/her care.
  • To be told of any experimental care and to be able to refuse to be part of the care. 
  • To make advance directives (a living will).
  • To file any complaint about not following your advance directive with the Ohio Department of Health.
  • To be free to carry out your rights and know that the OhioRISE Plan, our providers or the Ohio Department of Medicaid will not hold this against you.
  • To know that we must follow all federal and state laws, and other laws about privacy that apply.
  • To choose the provider that gives you care whenever possible and appropriate.
  • To be able to get a second opinion from a qualified provider in our network. If a qualified provider is not able to see you, we must set up a visit with a provider not in our network.
  • To get information about the OhioRISE Plan from us.
  • To make recommendations regarding the OhioRISE Plan’s member rights and responsibilities policy.
  • To contact the Ohio Department of Medicaid and/or the United States Department of Health and Human Services Office of Civil Rights at the addresses below with any complaint of discrimination based on a person’s age, race, color, national origin, religion, sex, gender identity, sexual orientation, religion, marital status, mental or physical disability, medical history, health status, genetic information, evidence of insurability or geographic location.


The Ohio Department of Medicaid

Office of Human Resources, Employee Relations
P.O. Box 182709
Columbus, Ohio 43218-2709
E-mail: ODM_EmployeeRelations@medicaid.ohio.gov
Fax: (614) 644-1434

 

Office for Civil Rights
United States Department of Health and Human Services
233 N. Michigan Ave. – Suite 240
Chicago, Illinois 60601
312-886-2359 (TTY: 312-353-5693)

 

Aetna follows state and federal civil rights laws that protect you from discrimination or unfair treatment. We do not treat people unfairly because of a person’s age, race, color, national origin, religion, sex, gender identity, sexual orientation, religion, marital status, mental or physical disability, medical history, health status, genetic information, evidence of insurability, or geographic location. 

 

If you would like to file a complaint, please contact Aetna by mail at Aetna Better Health of Ohio Grievance System Manager (P.O. Box 81139, 5801 Postal Road Cleveland, OH 44481). You can also file a grievance by phone. Just call Member Services at 1-833-711-0773 (TTY: 711) from 7 AM to 8 PM, Monday through Friday.

 

To help you understand this notice, language assistance, interpretation services, and auxiliary aids and services are available upon request at no cost to you. Services available include, but are not limited to, oral translation, written translation, and auxiliary aids. You can request these services and/or auxiliary aids by calling Member Services phone number 1-833-711-0773 (TTY: 711) from 7 AM to 8 PM, Monday through Friday.

Your responsibilities

  • Use your ID card when you go to healthcare appointments or get services. Do not let anyone else use your card.
  • Know the name of your primary care provider (PCP) and your care manager.
  • Know about your healthcare and the rules for getting care.
  • Tell us and your county caseworker when you make changes to your address, telephone number, family size and other information.
  • Be respectful to the healthcare providers who are giving you care.
  • Schedule your appointments, be on time and call if you are going to be late to or miss your appointment.
  • Give your healthcare providers all the information they need.
  • Tell us about your concerns, questions or problems.
  • Ask for more information if you do not understand your care or health condition.
  • Follow your healthcare provider’s advice.
  • Ask questions and talk to your provider about your health.
  • Tell us about any other insurance you have.
  • Tell us if you are applying for or get any other healthcare benefits.
  • Bring shots record to all appointments for members under 21 years old.
  • Give your doctor a copy of your advance directive.