Member rights and responsibilities

You have rights and responsibilities when receiving healthcare. As your healthcare partner, we want to make sure your rights are respected while providing your health benefits. That means giving you access to a broad network of doctors and healthcare professionals who help you make the best decisions for your health.

You have the right to:

  • Speak freely and privately with your doctors and other healthcare professionals about your options and medical treatment regardless of cost or whether it’s covered under your plan.
  • Work with your doctors and other healthcare professionals to make choices about your healthcare. 
  • Be treated with respect and dignity.
  • Expect us to keep your personal health information private by following our privacy policies and state and Federal laws.
  • Receive full disclosure about your health plan. You also have the right to share your feedback. This includes:
    • Our company and services.
    • Our network of doctors and other healthcare professionals.
    • Your rights and responsibilities.
    • The way your health plan works.
  • Make a complaint or file an appeal about:
    • Your health plan and any care you receive.
    • Any covered service or benefit decision that your health plan makes.
  • Say no to care for any condition, sickness, or disease without any affect on care you may receive in the future. If you decline treatment, you have the right to ask your doctors and other healthcare professionals how your health may be impacted now and in the future.
  • Get the most up-to-date information from a doctor about the cause of your illness, your treatment, and potential results. You can ask for help if you don’t understand this information.

You have the responsibility to:

  • Read all information about your medical benefits under the plan and ask for help if you have questions.
  • Follow all medical plan rules and policies.
  • Choose a Network primary care physician, also called a PCP, if your health plan requires it. 
  • Treat all healthcare professionals and staff with respect.
  • Keep all scheduled appointments. Call your doctor’s office if you will be late or need to cancel.
  • Understand your health challenges as well as you can, and work with your doctors and other healthcare professionals to create an agreed-upon treatment plan.
  • Inform your doctors and other healthcare professionals if you don’t understand the type of care or recommended actions.
  • Follow the agreed-upon treatment plan.
  • Share the information needed with us, your doctors, and other healthcare professionals to help you get the best possible care. This may include information about other health insurance benefits you have in addition to your coverage with us.
  • Inform Member Services if you have any changes to your name, address, or family members covered under your plan.

If you would like more information, have comments, or would like to contact us, please go to wellpoint.com and select Contact Us. Or call the Member Services number on your ID card.

 

We are here to provide high-quality benefits and service to our members. Benefits and coverage for services given under the plan are overseen by your Certificate of Coverage, Member Handbook or Schedule of Benefits and not by this Member Rights and Responsibilities statement.

 

Effective Date: 5/2011; Revised 2/2013, 1/2015, 4/2021; Reviewed annually with last review 1/2024

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Where can I find information about privacy practices?

 

Please visit Wellpoint's privacy practices page to learn more about our policies and procedures for the collection, use, and disclosure of your protected health information (PHI). This includes information about:

  • Notification of privacy practices
  • Use of authorization 
  • Access to medical records 
  • Protection of verbal, written and electronic information
  • Employer information