Rights and responsibilities
You have rights and responsibilities as an Aetna Better Health of Louisiana enrollee
As a Plan enrollee, you have rights and responsibilities. If you need help understanding your rights and responsibilities, call enrollee Services at 1-855-242-0802, TTY 711.
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Your rights
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As an enrollee, or the parent or guardian of an enrollee, you have the right to:
- Be treated with respect and with consideration for your dignity and privacy.
- Participate in decisions regarding your health care, including the right to refuse treatment for religious reasons or for any other reason.
- Talk about appropriate or medically necessary treatment options for your conditions. This should happen even if it is not a covered benefit and no matter how much it costs.
- Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
- Be able to request and receive a copy of your medical records, (one copy free of charge) and request that they be amended or corrected.
- Receive health care services that are accessible, are comparable in amount, duration and scope to those provided under Medicaid Fee-For-Service and are sufficient in amount, duration and scope to reasonably be expected to achieve the purpose for which the services are furnished.
- Receive services that are appropriate and are not denied or reduced solely because of diagnosis, type of illness, or medical condition.
- Receive all information in a manner and format that you can understand.
- Receive assistance from both LDH and the Enrollment Broker in understanding the requirements and benefits of Aetna Better Health of Louisiana.
- Receive oral interpretation services free of charge for all non-English languages.
- Be notified that oral interpretation is available and how to access those services.
- As a potential enrollee, to receive information about the Healthy Louisiana program, which populations may or may not enroll in the program, and Aetna Better Health of Louisiana’s responsibilities.
- Receive information on Aetna Better Health of Louisiana’s services, such as:
- Benefits covered
- What to do to get benefits, including any authorization requirements
- Any amounts you must pay (co-pays)
- Service area
- Names, locations, telephone numbers, and non-English language spoken by current contracted providers
- How and when you can change PCPs or see other providers
- Providers not accepting new patients
- Benefits not offered by Aetna Better Health of Louisiana but that you can get under Medicaid
- Receive information about your disenrollment rights at least annually.
- Receive notice of any changes in your benefits and services and to be informed at least 30 days before the change takes place.
- Receive information on grievance, appeal and State Fair Hearing procedures.
- Voice complaints, grievances, or file appeals about Aetna Better Health of Louisiana or the care you get.
- Receive information on emergency and after-hours coverage, such as knowing:
- The definition of emergency medical conditions, emergency services, and post-stabilization services
- That emergency services do not require prior authorization
- The process and procedures for obtaining emergency services
- The locations of any emergency settings and other locations at which providers and hospitals furnish emergency services and post-stabilization services covered under the contract
- Your right to use any hospital or other setting for emergency care
- Post-stabilization care services rules
- Receive our policy on referrals for specialty care and other benefits not provided by your PCP.
- Tell us what you think about our rights and responsibilities policy.
- Have your privacy protected.
- Exercise these rights without being treating negatively by Aetna Better Health of Louisiana, our providers, or LDH.
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Your responsibilities
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As an enrollee or the parent or guardian of an enrollee, you have the responsibility to:
- Use your ID cards when you go to health care appointments or get services and do not let anyone else use your card.
- Let us know if you lose your ID card or if it is stolen.
- 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.
- Tell us when you make changes to your address, telephone number, or other information.
- Understand your health problems and particiapte in setting your health goals.
- Let your provider know if your health changes.
- Be respectful to the health care providers who are giving you care.
- Asking questions of your providers to determine potential risks, benefits and costs of treatment alternatives.
- Following the prescribed treatment of care recommended by the provider or letting your provider know the reasons the treatment cannot be followed as soon as possible.
- Schedule your appointments during office hours when you can -- you also need to be on time and call if you are going to be late to or miss your appointment.
- Provide participating network providers with accurate and complete medical information.
- Tell us about your concerns, questions or problems.
- Ask for more information if you do not understand your care or health condition.
- Tell us about any other insurance you have or if you are applying for any new benefits.
- Bring shot records to al lapoointments for children under 18 years of age.
- Give your provider a copy of your living will or advance directive.
- Get all the preventive care you need to stay healthy, live a healthy lifestyle and avoid unhealthy activities.
- Follow the steps to file a grievance If you don’t agree with a provider and want to complain.