Member rights and responsibilities
Our members have rights and responsibilities. Our Member Services representatives serve as their advocates. Below are the rights and responsibilities of members.
Members have the right to:
Ensure every medical record is kept private, cared for with dignity and without discrimination. That includes the right to:
- Be treated fairly and with respect.
- Know medical records and discussions with providers will be kept private and confidential.
- Receive a copy of medical records (one copy free of charge); the
- Request that the records be amended or corrected.
Take part in making decisions about healthcare
Consent to or refuse treatment, and actively take part in treatment decisions and participate with practitioners to make decisions about healthcare. Members can refuse medical service or treatment at any time on religious grounds. In the case of a child, the parent or guardian may refuse treatment for the child.
Receive counseling or referral services that are not covered by Healthy Blue
If a member needs counseling or referral services that are not covered by Healthy Blue due to moral or religious objections, they may call the Enrollment Broker. For information on how to get these services, members may call 855-229-6848 (TTY 855-526-3346).
Receive care without restraint
Not be restrained or secluded if doing so is:
- For someone else’s convenience.
- Meant to force the member to do something they do not want to do.
- To get back at or punish a member.
Have access to healthcare services
Get healthcare services that are similar in amount and scope to those given under fee‑for‑service Medicaid. That includes the right to:
- Get healthcare services that will achieve the purpose for which the services are given.
- Get services that are fitting and are not denied or reduced due to:
- Type of illness.
- Medical condition.
Receive all information in a manner that may be easily understood
Be given information in a manner and format that is understandable. That includes:
- Enrollment notices.
- Information about health plan rules, including healthcare services and how to get them.
- Treatment options and alternatives, regardless of cost or whether it is part of covered benefits.
- A complete description of disenrollment rights at least annually.
- Notice of any key changes in the benefits package at least 30 days before the effective date of the change.
- Information on the grievance, appeal, and state fair-hearing procedures.
- A list of member rights and responsibilities.
Receive a member welcome packet at least once a year if needed, including a copy of the member handbook.
Discuss appropriate or medically necessary treatment options for conditions, regardless of cost or benefit coverage.
Get information about the Healthy Blue health plan prior to joining Healthy Blue
Receive information about Healthy Louisiana offered through Healthy Blue so that members can make an informed choice. That includes:
- Basic features of Healthy Blue.
- The populations that may or may not enroll in the program.
- The responsibility of Healthy Blue to arrange care in a timely manner.
Receive information on Healthy Blue services
Receive information on Healthy Louisiana services, the organization, its practitioner's and providers offered through Healthy Blue. That includes:
- Covered benefits.
- Procedure for getting benefits, including any prior approval requirements.
- Any copay requirements.
- Service area.
- Names, locations, phone numbers, and non-English languages spoken by current contracted providers, including, at a minimum:
- Any restriction on freedom of choice of network providers.
- Names of providers who are not accepting new patients.
- Benefits not offered by Healthy Blue but that members can obtain and how to get them; this includes how transportation is offered.
- Service utilization policies.
- Request a copy of our guidelines by calling Member Services.
- Member rights and responsibilities.
Get information on emergency and after-hours coverage
Receive detailed information on this coverage. That includes:
- What constitutes an emergency medical condition, emergency services, and post‑stabilization services
- Post-stabilization rules.
- Notice that emergency services do not require prior approval.
- The process and procedures for getting emergency services.
- The locations of any emergency settings and other sites where providers and hospitals furnish emergency and post-stabilization covered services.
- The right to use any hospital or other setting for emergency care.
- Getting the Healthy Blue policy on referrals
- Receiving the Healthy Blue policy on referrals for specialty care and other benefits not given by PCP.
Get help from the Louisiana Department of Health (LDH) and the Enrollment Broker
Know the requirements and benefits of the Louisiana Medicaid Coordinated Care Networks program.
Get oral interpretation services
Receive oral interpretation services. That includes the right to:
- Receive these services free of charge for all non-English languages, not just those known to be common.
- Be told these services are offered and how to access them.
Exercise rights without adverse effects
Exercise rights without adverse effects on the way Healthy Blue, our providers, or LDH treats members. That includes the right to:
- Tell us complaints or file an appeal about Healthy Blue or the care or services you receive from our providers.
- Make recommendations regarding rights and responsibilities as a Healthy Blue member.
Members have the responsibility to:
Learn about their rights
Learn and understand each right under the Medicaid program. That includes the responsibility to:
- Ask questions if a member does not understand their rights.
- Learn what choices of health plans are available in their area.
Learn and follow health plan and Medicaid rules
Abide by the health plan Medicaid policies and procedures. That includes the responsibility to:
- Carry Healthy Blue and Medicaid ID cards at all times when getting healthcare services.
- Let health plan know if ID card is lost or stolen.
- Never loan, sell or give ID card to anyone else — doing so could result in loss of eligibility or legal action.
- Let health plan know right away if the member has a Worker’s Compensation claim or a pending personal injury or medical malpractice lawsuit or been involved in an auto accident.
- Learn and follow health plan and Medicaid rules.
- Learn and follow plans and instructions for care, as agreed upon with providers.
- Make any changes in their health plan and PCP in the ways established by Medicaid and by the health plan.
- Keep scheduled appointments.
- Cancel appointments in advance when they cannot be kept.
- Always contact PCP first for nonemergency medical needs.
- Be sure approval from their PCP is obtained before going to a specialist.
- Understand when they should and should not go to the emergency room.
Tell providers about their healthcare needs
Share information relating to health status with PCP and become fully informed about service and treatment options. That includes the responsibility to:
- Tell their PCP about their health.
- Talk to providers about healthcare needs and ask questions about the different ways healthcare problems can be treated.
- Help providers get medical records.
- Provide providers with the right information.
- Follow the prescribed treatment of care recommended by the provider or let the provider know the reasons the treatment cannot be followed as soon as possible.
Take part in making decisions about health
Actively participate in decisions relating to service and treatment options, make personal choices and take action to maintain health. That includes the responsibility to:
- Work as a team with their provider in deciding what healthcare is best.
- Participate in developing mutually agreed-upon treatment goals with providers.
- Understand how certain behaviors can affect health.
- Do the best they can to stay healthy.
- Treat providers and staff with respect.