Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements
View requirements for Local Plan and BlueCard Out-of-Area members.
Search our online provider directory when you need a doctor, hospital, or other health care provider.
Member Rights and Responsibilities
Member Rights and Responsibilities
As a member, you have certain rights and responsibilities when receiving your health care. You also have a responsibility to take an active role in your care.. As your health care partner, we’re committed to making sure your rights are respected while providing your health benefits. That also means giving you access to our network providers and the information you need to make the best decisions for your health and welfare.
These are your rights and responsibilities:
You have the right to:
| Speak freely and privately with your doctors and other health providers about all health care options and treatment needed for your condition. This is no matter what the cost or whether it is covered under your plan.|
| Work with your doctors in making choices about your health care.|
| Be treated with respect and dignity.|
| Expect us to keep your personal health information private. This is as long as it follows state and Federal laws and our privacy policies.|
| Get the information you need to help make sure you get the most from your health plan, and share your feedback. This includes information on:|
our company and services.
our network of doctors and other health care providers .
your rights and responsibilities.
the rules of your health care plan.
the way your health plan works.
| Make a complaint or file an appeal about:|
your health care plan.
any care you get.
any covered service or benefit ruling that your health care plan makes.
| Say no to any care, for any condition, sickness or disease, without it affecting any care you may get in the future. This includes the right to have your doctor tell you how that may affect your health now and in the future.|
| Get all of the most up-to-date information from a doctor or other health care provider about the cause of your illness, your treatment and what may result from it. If you don’t understand certain information, you can choose a person to be with you to help you understand.|
You have the responsibility to:
| Read and understand, as well as you can, all information about your health benefits or ask for help if you need it.|
| Follow all health care plan rules and policies.|
| Choose a network primary care physician (doctor), also called a PCP, if your health plan requires it.|
| Treat all doctors, health care providers and staff with courtesy and respect.|
| Keep all scheduled appointments with your health care providers. Call their office if you may be late or need to cancel.|
| Understand your health problems as well as you can and work with your doctors or other health care providers to make a treatment plan that you all agree on.|
| Tell your doctors or other health care providers if you don’t understand any type of care you’re getting or what they want you to do as part of your care plan.|
| Follow the care plan that you have agreed on with your doctors and other health care providers.|
| Give us, your doctors and other health care providers the information needed to help you get the best possible care and all the benefits you are entitled to. This may include information about other health and insurance benefits you have in addition to your coverage with us.|
| Let our Member Service department know if you have any changes to your name, address or family members covered under your plan.|
We are committed to providing high quality benefits and customer service to our members. Benefits and coverage for services provided under the benefit program are overseen by the Subscriber Agreement (your signed benefit contract) and not by this Member Rights and Responsibilities statement.
If you need more information or would like to contact us, please go to anthem.com
and select Customer Support > Contact Us. Or call the Member Services number on your ID card.