MEMBER RIGHTS AND RESPONSIBILITIES

We want all of our members to enjoy the best care and service. To do that, we promise to do our part to meet your healthcare needs. There are also things you can do to take charge of your own healthcare.

Our Promise To You

You have the right to:

  • Get information from us, our providers, and business partners
  • Access quality care
  • Choose or change your doctor at any time (HMO members may change their primary care provider up to six times per year)
  • Speak freely and privately with your doctors about your care
  • Have your information kept secure in accordance with BCBSAZ’s Privacy Practices (see azblue.com/legal/privacy)
  • Know who can get your private information
  • Know BCBSAZ’s security policy (see azblue.com/legal/privacy)
  • Be treated with respect and dignity
  • File a complaint or challenge a decision we make
  • Know how long it will take us to reply to and resolve your issue
  • Get information that is easy to grasp
  • Get information about end-of-life planning and advance directives

Your Promise To Us

It is your responsibility to:

  • Read the information we give you and ask questions when you need to know more
  • Know how to get care and supplies that are covered under your plan
  • Follow the rules of your health plan
  • Let us know of changes related to how we can reach you
  • Treat us, and the doctors and hospitals you get care from, with respect
  • Give us information we need to help you
  • Give doctors and hospitals honest information about yourself
  • Understand your health and work with your doctor on a care plan that is right for you
  • Do as your doctor advises for your health
  • Talk to your doctor before you change something with your healthcare plan
  • Keep scheduled visits with your doctors
  • Pay your cost share when it is due

The Patient’s Bill of Rights under the
Affordable Care Act (ACA)

Under the law, a “Patient’s Bill of Rights” aims to help you make informed choices about your health. These tenets apply to all BCBSAZ non-grandfathered plans in effect after March 23, 2010:

The Patient’s Bill Of Rights:

  • Provides coverage to those with pre-existing conditions*
  • Protects your choice of doctors: Choose any primary care doctor you want from your plan’s network
  • Allows young adults to stay covered on a parent’s plan up to age 26
  • Ends lifetime limits on coverage, banning them for all new health insurance plans
  • Stops your insurance from being dropped if you make an honest mistake on your application
  • Reviews premium increases: Insurance companies must now publicly say why rate hikes (above a certain level) may be needed for small group plans and individual and family plans
  • Helps you get the most from your premium dollars: Most of your premium dollars must be used for your healthcare – not for administrative costs
  • Ended annual dollar limits on essential covered services in 2014
  • Continues to allow you to get emergency care at a hospital outside of your health plan’s network without a referral. (Note: For some plans, out-of-network providers may bill you for a balance owed above BCBSAZ’s allowed amount.)
Since the Patient’s Bill of Rights became law, some additional rights and protections apply. The healthcare law:
  • Requires that non-grandfathered plans cover most preventive services in-network at no cost share.
  • Continues to guarantee your right to appeal: You have the right to ask your insurer to reconsider its decision to deny authorization for a service or refusal to pay a claim. This has been the law in Arizona for many years, and it is reflected in federal law through the ACA.**

*In effect for non-grandfathered employer group plans on that plan’s renewal date in 2014.

In effect for non-grandfathered individual and family plans on Jan. 1, 2014.

**Complaints and appeal information and forms are available to members at azblue.com/individualsandfamilies/resources/appeals-and-grievances.

ADDITIONAL LINKS

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