Medicaid

Know your rights and responsibilities

You have rights and responsibilities.  If your child is a member, he or she has the rights and responsibilities personally and through his or her parents, caretaker or legal guardian. You can read your rights and responsibilities in your member handbook or below. It's important that you read and understand each one. Call Member Services if you have questions at 1-866-638-1232 or TTY 7-1-1.

You have the right to:  

  • Fair treatment and respect
  • Privacy and to be treated with dignity
  • Covered services.  Your race, ethnic group, original country, language, religion, gender identification and age don’t matter.  Your mental or physical problems, sexual preference and family medical history don’t matter. Your ability to pay doesn’t matter.
  • Good quality medical services that support your personal beliefs, medical condition and background
  • Get information from your provider about appropriate or medically necessary treatment options and alternatives for your condition(s) regardless of cost or benefit coverage in a manner appropriate to your ability to understand
  • Get information about the organization, its services, its practitioners and providers and member rights and responsibilities  
  • Get information regarding the cost of your care
  • Get language services if you don’t speak English, if you’re deaf or if you have hearing problems.  You can get written information in a different format.
  • Participate with the providers that make decisions about your health care. You can have a friend or family member help you with health care decisions when needed. Your rights include many things
    • Choosing your own participating PCP
    • Knowing about all your treatment choices and risks
    • Knowing if care or treatment is part of a research experiment before you have it
    • Saying no to experimental (unproven) treatments
    • Getting health information from your PCP
    • Getting information about medical procedures and who will do them
    • Choosing who can be with you for treatments and examinations
    • Asking to have a female in the room for breast and pelvic exams
    • Refusing a treatment, including leaving the hospital
    • Asking what happens if you refuse treatment. You don’t have to follow a treatment plan to be eligible for medical care.
    • Stopping medications
    • Getting necessary and covered services from an out-of-network provider for as long as Aetna Better Health is unable to provide the service in circumstances where the plan cannot offer a choice of two qualified specialists
    • Getting a second opinion at no cost to you
    • Receiving medical services when admitted to an Emergency Room. Your treatment can’t be delayed because of the insurance you have or your ability to pay.
  • Be free from any form of restraint or seclusion as a means of force, discipline, revenge or convenience
  • Privacy - your personal and medical information will only be given out as allowed by law. You have a right to:
    • Get a copy of your medical records
    • Ask for additions or corrections to the records
    • Ask how health care information is use
    • Talk to health care professionals and case managers in private
  • Use all your member rights without being treated differently or losing any health care services by Aetna Better Health, its providers, or the Department of Public Welfare
  • Have an Advance Directive (living will and durable power of attorney) and receive notification of any change to an applicable State law as soon as possible, but no later than 90 days after the date it goes into effect. 
  • Voice complaints and grievances about Aetna Better Health and its services
  • Report concerns to Aetna Better Health about the organization
  • Make recommendations regarding the organization’s member rights and responsibilities policy

You have the responsibility to:   

  • Know the name of your PCP and your case manager if you have one
  • Know about your health care and the rules for getting care
  • Respect the health care professionals who give you care
  • Tell Aetna Better Health about your concerns, questions or problems 
  • Give your health care providers all the information they need
  • Ask for more information if you don’t understand your treatment or health condition
  • Contribute to your own health by telling your provider about your health care concerns, needs and goals
  • Follow plans and instructions for care that you agreed to with your providers
  • Protect your member ID card and show it when you get services
  • Tell us about any other insurance you have
  • Tell us if you apply for other health care benefits
  • Make appointments during office hours
  • Be on time for appointments            
  • Call the provider’s office 24 hours ahead if you need to cancel an appointment
  • Bring shots record to all appointments for children under 18 years old