Rights and responsibilities

Both our members and providers have rights and responsibilities. Our Member Services representatives serve as their advocates.

Member rights

Healthy Blue members have the right to:

Be treated with respect and with due consideration for their dignity and privacy
Expect that we will treat their records, including medical and personal information and communications, confidentially
Request and receive a copy of their medical records at no cost to the member and may request that the records be amended or corrected
Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation as specified in federal regulations

Receive information on available treatment options and alternatives, presented in a manner appropriate to the member’s condition and ability to understand
Engage in candid discussions of appropriate or medically necessary treatment options for their conditions regardless of cost or benefit coverage
Receive the appropriate services that are not denied or reduced solely because of medical condition
Refuse healthcare (to the extent of the law) and understand the consequences
Decide ahead of time the care they want if they become sick, injured, or seriously ill by making a living will
Be able to make decisions about their children’s healthcare if members are younger than age 18 and married, pregnant, or have children

Pursue resolution of grievances and appeals about the health plan or care provided
Freely exercise filing a grievance or an appeal without adversely affecting the way they are treated
Continue to receive benefits pending the outcome of an appeal or a fair hearing under certain circumstances, where allowed by law

Receive the necessary information to be a Healthy Blue member in a manner and format they can understand easily
Receive a current member handbook and provider directory
Receive a copy of the member handbook and/or provider directory by request by calling Member Services at 833-838-2593 
Receive assistance from Healthy Blue in understanding the requirements and benefits of the plan
Receive notice of any significant changes in the benefit package at least 30 days before the intended effective date of the change
Make recommendations about our rights and responsibilities policies
Know how we pay our providers

Choose their PCPs from our network of providers
Choose any Healthy Blue network specialist after getting a referral from their PCPs, if appropriate
Be referred to healthcare providers for ongoing treatment of chronic disabilities
Have access to their PCPs or backups 24 hours a day, 365 days a year for urgent or emergency care
Get care right away from any hospital when their symptoms meet the definition of an emergency medical condition
Get post-stabilization services following an emergency medical condition in certain circumstances
Be free from discrimination and receive covered services without regard to race, color, creed, gender, religion, age, national origin ancestry, marital status, sexual preference, health status, income status, program membership, or physical or behavioral disability, except where medically indicated

Members have the responsibility to:

Treat their doctors, their doctors’ staff, and employees of Healthy Blue with respect and dignity
Not be disruptive in the doctor’s office
Make and keep appointments and be on time
Call if they need to cancel an appointment, change the appointment time, or call if they will be late
Respect the rights and property of all providers

Tell their providers about their symptoms and problems, and ask questions
Supply information providers need in order to provide care
Understand the specific health problems and participate in developing mutually agreed-upon treatment goals as much as they are able
Discuss problems they may have with following their providers’ directions
Follow plans and instructions for the care they have agreed to with their practitioners
Consider the outcome of refusing treatment recommended by a provider
Discuss grievances, concerns, and opinions in an appropriate and courteous way
Help their providers obtain medical records from their previous providers and help their providers complete new medical records as necessary
Secure referrals from their PCPs when specifically required before going to another healthcare provider unless they have a medical emergency
Know the correct way to take medications
Go to the emergency room when they have an emergency
Notify their PCPs as soon as possible after they receive emergency services
Tell their doctor who they want to receive their health information

Provide proper identification during enrollment
Carry their Healthy Blue ID cards with them at all times, and report any lost or stolen cards
Contact the KanCare Member Enrollment Center at 866-305-5147 or Healthy Blue Member Services at 833-838-2593 if information on their ID cards is wrong
Contact the KanCare Clearinghouse if there are changes to their name, address, or marital status
Call us and change their PCP before seeing the new PCP
Tell us about any doctors they are currently seeing
Notify Healthy Blue if a member or family member who is enrolled in Healthy Blue has died
Report suspected fraud, waste, and abuse

Our Healthy Blue providers also have rights and responsibilities, such as the right to:

Obtain information about the organization’s services, staff qualifications, and any contractual relations
Decline to participate in or work with the organization’s programs and services on behalf of their patients
Be informed how the organization coordinates interventions with care plans for individual members
Know how to contact the care coordinator responsible for managing and communicating with their patients
Be supported by the organization when interacting with members to make decisions about their healthcare
Receive courteous and respectful treatment from the organization’s staff
Communicate complaints to the organization

We look forward to working with you to provide quality service for our members.