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.

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.

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.