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Member Rights and Responsibilities

Arizona Complete Health-Complete Care Plan’s goal is to provide high-quality medical and behavioral health care. We also promise to listen, treat you with respect, and understand your individual needs. Members have rights and responsibilities. The following is a description of your rights as an Arizona Complete Health-Complete Care Plan member.

As a member, you have the right to:

  • File a complaint about the managed care organization (Arizona Complete Health-Complete Care Plan). Please call us at Member Services if you have any issues with your care.
  • Request information on the structure and operation of Arizona Complete Health-Complete Care Plan or our subcontractors.
  • Request information on whether Arizona Complete Health-Complete Care Plan has physician incentive plans (PIP) that affect the use of our referral services.
  • Know the types of compensation arrangements Arizona Complete Health-Complete Care Plan uses.
  • Know whether stop-loss insurance is required.
  • Receive a summary of member survey results.
  • The members’ right to be treated fairly regardless of race, ethnicity, national origin, religion, gender, age, age, behavioral health condition (intellectual) or physical disability, sexual preference, genetic information, or ability to pay.
  • A second opinion for a qualified health professional within the network, or have a second opinion arranged outside the network, only if there is not adequate in-network coverage at no cost to the enrollee.
  • Receive information on available treatment options and alternatives, presented in a manner appropriate to your condition and ability to understand the information.
  • Be provided with information about formulating advance directives with your health care providers.
  • Request and receive annually, at no cost, a copy of your medical records. We must reply to your request for medical records within thirty (30) days. This response will either be a copy of your records, or a reason for denying your request. If a request is denied, in whole or in part, we must give you a written denial within sixty (60) days that includes the reason for the denial, your rights to disagree, and your rights to include your amendment with any future disclosures of your health information as allowed by law. Your right to access medical records may also be denied if the information is psychotherapy notes, compiled for, or in a reasonable anticipation of a civil, criminal or administrative action, protected health information subject to Federal Clinical Laboratory Improvement Amendments of 1988 or exempt pursuant to 42 CFR Part 164.
  • Amend or correct your medical records as allowed by law.
  • Be free from any restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.
  • Receive information on beneficiary and plan information.
  • Be treated with respect, and recognition of your dignity and right to privacy. We understand your need for privacy and confidentiality, including protection of any information that identifies you.
  • Participate in decision-making regarding your health care, including the right to refuse treatment from a provider and have a representative facilitate care or treatment decisions when you are unable to do so.
  • Have a list of available providers as part of Arizona Complete Health-Complete Care Plan’s Provider Directory, including those who speak a language other than English and are able to accommodate members with disabilities.
  • Use any hospital or other setting for emergency care without approval.
  • Select a primary care physician (PCP) from Arizona Complete Health-Complete Care Plan’s participating PCPs.
  • For members in a HCBS or a behavioral health residential setting that have completed an Advance Directive, the document must be kept confidential but be readily available. For example: in a sealed envelope attached to the refrigerator.
  • Know any restrictions on your freedom of choice among network providers.
  • Receive information in a language and format that you understand.
  • Be provided with information regarding grievance, appeals and request for hearing.
  • Have access to review medical records in accordance with applicable federal and state laws.
  • Request a copy of the Notice of Privacy Practices at no cost to you. The notice describes Arizona Complete Health-Complete Care Plan’s privacy practices and how we use health information about you and when we may share that health information with others. Your health care information will be kept private and confidential. It will be given out only with your permission or if the law allows it.
  • Respect and Dignity
    • Get your services in a safe environment.
    • You can get behavioral and medical services that support your personal beliefs, medical condition, and background in a language you understand.
  • Treatment Decisions
    • Receive information on treatment options and alternatives, appropriate to your condition, in a way that you are able to understand and allows you to participate in decisions about your health care.
    • Decide who you want with you during treatment and agree to or refuse treatment services, unless the services are court ordered.