Patient Rights and Responsibilities

As a Carelon Health patient, you have rights and responsibilities when receiving care. As your healthcare team, we want to make sure your rights are respected. That means giving you access to our network of healthcare providers and giving you the information you need to make the best decisions for your health. As a patient, you should also take an active role in your care.

You have the right to:

  • Be treated with respect and dignity.
  • Be safe from discrimination based on race, ability, religion, gender, sexual orientation, health, ethnicity, beliefs, age, or national origin.
  • Get healthcare services in your preferred spoken or written language or an alternative format you understand.
  • Speak freely and privately with your care team about all care options and treatments needed, no matter what the cost or whether it is covered by Carelon Health.
  • Get the most up-to-date information from a healthcare provider about the cause of your illness, your treatment, and what may result from it. You can ask for help if you do not understand the information given to you.
  • Work with your doctors to make decisions about your care.
  • Share your feedback.
  • Get a copy of your medical record if you request it.
  • Have your health information kept private as described in our privacy policy and as described in state and federal laws.
  • Say “no” to care for any condition, sickness, or disease without having it affect any care you may receive in the future. This includes asking your healthcare provider to tell you how that may affect your health, now and in the future.
  • Get the information you need to make sure you get the most from your healthcare. This includes information about:
    • Our company’s programs and services.
    • How to opt in or out of programs.
    • Our network of healthcare providers.
    • How to make a complaint or file an appeal.

You have the responsibility to:

  • Read all the information about your health benefits and ask for help if you have questions.
  • Follow all rules and policies.
  • Refrain from taking photos, videos, or any other recordings in a Carelon Health Care Center unless you have been given permission to do so for a care-related purpose.
  • Treat all doctors and other healthcare providers and staff with respect.
  • Keep all scheduled appointments and call your healthcare provider’s office if you may be late or need to cancel.
  • Understand your healthcare needs as well as you can and work with your healthcare providers to make a care plan that you all agree on.
  • Ask your healthcare provider for more information if you do not understand the type of care you are receiving or what you are supposed to do.
  • Follow the care plan that you have agreed upon with your healthcare provider.
  • Go to the emergency room only in the case of true emergencies or as directed by your healthcare provider.
  • Tell healthcare providers you are a part of Carelon Health. Present your membership card before receiving care.
  • Give healthcare providers all the information needed so they can help you get the best care possible. This may include information about other health insurance benefits you have in addition to coverage from us.
  • Make copayments for your covered services and payments for services that are not covered.
  • Call the Member Services number on the back of your health plan member ID card if you have any changes to your name, address, or telephone number.
  • For Advanced Primary Care patients in applicable Medicare Advantage plans, use in-network healthcare providers.

If you would like more information, have comments, or would like a copy of the Patient Rights and Responsibilities in other formats, please Contact us or call the Member Services number on the back of your health plan member ID card.

Affirmative statement:

  • Carelon Health utilization management decision-making is based only on appropriateness of care, services, and the existence of coverage.
  • Carelon Health does not reward healthcare providers or other individuals for issuing denials of coverage or care.
  • Financial incentives for utilization management decision makers do not encourage decisions that result in underutilization.