Rights and Responsibilities

Your rights

As an Aetna Better Health member, you have the right to:

  • Be informed of Aetna Better Health and all covered services
  • Receive information about Aetna Better Health, our services, doctors, other providers, and member rights and responsibilities
  • Be treated with respect, dignity and the right to privacy
  • Choose your personal Aetna Better Health doctor/primary care provider (PCP)
  • Change your Aetna Better Health primary care provider (PCP)
  • Be treated regardless of race, gender, religion, disability, ethnicity, national origin, or source of payment
  • Expect all information about your health to be confidential and to have your privacy protected
  • Not have your medical records shown to others without your approval, unless allowed by law
  • Receive information from your doctor about treatment options or other types of care available to you, appropriate to your condition, and explained in a way you can understand
  • Receive services from out of network doctors/providers
  • Receive a second opinion on a medical procedure from an in‑plan doctor/provider. If an Aetna Better Health provider is not available, we will help you get a second opinion from a non‑participating provider at no cost to you
  • Participate with your doctor/provider in making decisions about your health care
  • Tell the doctor/provider that you do not want treatment, and be told what may happen if you do not have the treatment. You can continue to get Medicaid and medical care without any repercussions even if you say no to treatment
  • Make an official complaint or grievance about Aetna Better Health or file an appeal if you are not happy with the answer to your question, complaint/grievance, or care given
  • Appeal a medical decision made by Aetna Better Health directly to the Department of Medical Assistance Services (DMAS)
  • Know the cost to you if you choose to get a service that Aetna Better Health does not cover
  • Be told in writing by Aetna Better Health when any of your health care services requested by your PCP are reduced, suspended, terminated or denied. You must follow the instructions in your notification letter
  • Have you and/or your child’s doctor/provider tell you about treatment choices you may have, no matter what the cost or benefit coverage
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation
  • Find out what is in your medical records and request that they be corrected or amended
  • Request a copy of your medical records
  • Exercise your rights and to know that you will not have any retaliation against you by Aetna Better Health, any of our doctors/providers or state agencies
  • Access to health care services and medical advice twenty‑four (24) hours a day, seven (7) days a week, including urgent and emergency services
  • Get family planning services from any participating Medicaid provider without prior authorization
  • Get information in different formats (i.e., large print, Braille, etc.), at no cost to you, if needed and in an easy form that takes into consideration the special needs of those who may have problems seeing or reading
  • Get interpretation services if you do not speak English or have a hearing impairment to help you get the medical services you need
  • Make recommendations or suggestions regarding Aetna Better Health’s member rights and responsibilities
  • Develop Advance Directives or a Living Will, which tell how to have medical decisions made for you if you are not able to make them for yourself
  • Ask for a description of all types of payment arrangements that we use to pay providers for health care services

Your responsibilities

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

  • Reading the member handbook. It tells you about Aetna Better Health services and how to file a complaint or grievance
  • Schedule wellness check‑ups. Members under twenty‑one (21) years of age need to follow the Early Periodic Screening Diagnosis and Treatment [EPSDT] schedule
  • Get care as soon as you know you are pregnant. Keep all prenatal appointments
  • Carrying with you and showing your Aetna Better Health identification (ID) card to each doctor before getting health services
  • Protecting your member ID card and not sharing it with others
  • Getting medical care from providers in our networ
  • Knowing the name of your assigned PCP
  • Telling the doctor that you and/or your child are/is a member of Aetna Better Health at the time that you speak with the doctor’s office
  • Keeping doctor’s appointments or calling to cancel them at least twenty‑four (24) hours ahead of time
  • Using the emergency room (ER) for true emergencies only
  • Learning the difference between emergencies and when you need urgent care
  • Treating the doctors/providers, staff and people providing services to you with respect
  • Giving all information about your health to Aetna Better Health and your doctor in order to provide care
  • Telling the doctor if you do not understand what they tell you about your health so that you and your doctor can make health plans together
  • Following what you and your doctor agree to do including making follow up appointments, taking medicines and following your doctor’s care instructions
  • Telling Aetna Better Health and DMAS when your address changes
  • Telling Aetna Better Health about changes in your family that might affect your eligibility or enrollment such as family size, employment, and moving out of the state of Virginia
  • Telling Aetna Better Health if you have other health insurance, including Medicare
  • Giving your doctor a copy of your Living Will and/or Advance Directive
  • Learning about prescription drugs and reasons for taking them
  • Letting Aetna Better Health know how we can work better for you 

DMAS pays us a monthly premium for your Aetna Better Health coverage. If you are found not eligible for Aetna Better Health coverage for past months because you did not give truthful information to your case worker or tell your case worker about changes in your circumstances, you may have to pay DMAS back for these premiums even if you do not get medical services under Aetna Better Health benefits during these months.