Legal & Mandates
- 2015 ACA Rate Increase Justification
- Patient Rights & Responsibilities
- Health Care Fraud Prevention
- Quality Improvement
- Mental Health Parity
- MD Proposed Rate Increase Law
- Virginia Claims or Coverage Denials
Rights and Responsibilities
CareFirst BlueCross BlueShield / CareFirst BlueChoice Members' Rights and Responsibilities Statement
- Members have a right to be treated with respect and recognition of their dignity and right to privacy.
- Members have a right to receive information about the health Plan, its services, its practitioners and providers, and members' rights and responsibilities.
- Members have a right to participate with practitioners in decision making regarding their health care.
- Members have a right to a candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage.
- Members have a right to make recommendations regarding the organization's members' rights and responsibilities policies.
- Members have a right to voice complaints or appeals about the health Plan or the care provided.
- Members have a responsibility to provide, to the extent possible, information that the health Plan and its practitioners and providers need in order to care for them.
- Members have a responsibility to understand their health problems and participate in developing mutually agreed upon treatment goals to the degree possible.
- Members have a responsibility to follow the plans and instructions for care that they have agreed on with their practitioners.
- Members have a responsibility to pay member copayments or coinsurance at the time of service.
- Members have a responsibility to be on time for appointments and to notify practitioners/providers when an appointment must be canceled.
Eligible Individuals' Rights Statement Wellness and Health Promotion Services
- Eligible individuals have a right to receive information about the organization, including wellness and health promotion services provided on behalf of the employer or plan sponsors; organization staff and staff qualifications; and any contractual relationships.
- Eligible individuals have a right to decline participation or disenroll from wellness and health promotion services offered by the organization.
- Eligible individuals have a right to be treated courteously and respectfully by the organization's staff.
- Eligible individuals have a right to communicate complaints to the organization and receive instructions on how to use the complaint process that includes the organization's standards of timeliness for responding to and resolving complaints and quality issues.
To request a paper copy of the Members' Rights and Responsibilities, call the Member Services phone number on your ID card.