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Your rights and responsibilities

Family at outdoor event

Your rights

As a member of Healthy Blue, you have a right to:

  • Make recommendations regarding your rights and responsibilities as a Healthy Blue member
  • Be cared for with respect and dignity, without regard for health status, sex, race, color, religion, national origin, age, marital status, sexual orientation, or gender identity
  • Expect us to keep your personal health information private as long as it follows state and federal laws and our privacy policies
  • Receive information on services offered through Healthy Blue. That includes:
    • Covered benefits
    • Procedures for getting benefits, including any prior approval requirements
    • How to request and get a provider directory at any time
    • Names, locations, and phone numbers of, and non-English languages spoken by, current providers in our plan, including, at a minimum:
      • Primary care providers (PCPs)
      • Specialists
      • Hospitals
    • Viewing the latest provider directory
    • How to request and get a member handbook. See the latest member handbook.
  • Get the following from us, if you ask for it. Call Member Services at 1-844-594-5070 (TTY 711) for:
    • Information on Healthy Blue and its services
    • The professional qualifications of health care providers
  • Be told where, when and how to get the services you need from Healthy Blue
  • Take part with your doctors in making decisions about your health care
  • An open discussion with your primary care provider (PCP) of suitable or medically needed treatment options for your condition, regardless of cost or benefit coverage, including being told what is wrong, what can be done for you, and what will likely be the result, in a language you understand
  • Get a second opinion about your care
  • Take part in decisions about your health care, including the right to:
    • Say no to treatment and be told what you may risk if you do
    • Create an advance directive
    • File grievances and appeals
    • Have a candid discussion on medically necessary treatment options for your health condition(s), regardless of cost or benefits covered
  • Get a copy of your medical record and talk about it with your PCP, and to ask, if needed, that your medical record be amended or corrected
  • Use the Healthy Blue complaint process to settle complaints or appeals, or contact the Medicaid Managed Care Ombudsman Program any time you feel you were not fairly treated
  • Use the State Fair Hearing system
  • Appoint someone you trust (relative, friend, or lawyer) to speak for you if you are unable to speak for yourself about your care and treatment
  • Receive considerate and respectful care in a clean and safe environment free of unnecessary restraints

Your responsibilities

As a member of Healthy Blue, you agree to:

  • Work with your PCP to protect and improve your health
  • Try to understand your health problems and take part in developing treatment goals
  • Tell your PCP about medical and personal information that may affect your health and the care you receive
  • Help your PCP get medical records from providers who have treated you in the past
  • Give your approval of any treatment or plan for your care after that plan has been fully explained to you
  • Follow your PCP’s advice and plan of care you have agreed to
  • Follow instructions you get from your doctor and other providers
  • Ask questions or for more explanation if you do not understand your doctor’s instructions
  • Call or go back to your PCP if you do not get better or ask for a second opinion
  • Treat health care staff with the respect you expect yourself
  • Tell us if you have problems with any health care staff by calling Member Services at 1-844-594-5070
  • Keep your appointments. If you must cancel, call as soon as you can.
  • Use the emergency department only for real emergencies
  • Call your PCP when you need medical care, even if it is after-hours