Rights & Responsibilities
As a Cenpatico-IC member you have certain rights and responsibilities. Below is a list of those rights and responsibilities. It is important that you understand each one, if you would like to talk to someone about these rights and responsibilities please contact Member Services at 1-866-495-6738, TTY/TDD 1-877-613-2076.
Behavioral Health Rights and Responsibilities
Your Rights as a Behavioral Health Member
- Respect and Dignity
- Get your services in a safe environment;
- Be treated fairly and with respect regardless of your race, ethnicity, national origin, religion, mental or physical disability, gender, sex, age, sexual orientation, ability to pay, or ability to speak English;
- You can get behavioral and medical services that support your personal beliefs, medical condition, and background in a language you understand; and,
- You can get interpretation services at no cost to you if you do not speak English or have a hearing impairment. You may ask for materials in other formats. Call Member Services for assistance 1-866-495-6738, TTY/TDD 1-877-613-2076.
- Treatment Decisions
- Choose a provider within the Cenpatico-IC Provider Network and change your assigned providers;
- Have your protected health information kept private, unless there is a reason to share your health information (see page 26 for limits to confidentiality);
- Get a second opinion from a qualified health care professional within the network, or have a second opinion arranged outside of the network at no cost to you if there are no other in-network options;
- Receive information on treatment options and alternatives 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;
- Know the cost for a service that you choose but Cenpatico-IC does not cover;
- Receive, inspect, and amend your medical records at no cost to you (see page 27 for more information); and,
- Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.
- Complaint and Legal Rights
- File a complaint, grievance, or appeal about the Arizona Department of Health Services, Cenpatico-IC, and/or Cenpatico-IC’s providers without penalty;
- Make an advance directive and know how to have medical decisions made for you if you are not able to make them for yourself; and,
- The same civil and legal rights as anyone else.
- Know more about
- Your rights and protections;
- The amount, duration, and scope of your benefits;
- The criteria that is used to make decisions about your care and your coverage;
- Limits on your choice among network providers and the extent to which, and how, you may get benefits from out-of-network providers;
- How and where to access services including any cost sharing or copayments required;
- The process for getting services including approval requirements and criteria used to make decisions about the services you can get;
- The complaint, grievance, appeal, and fair hearing procedures and timeframes;
- Emergency services:
- Your right to use any hospital or emergency care facility without prior approval;
- A description of what an emergency medical condition is and how to get emergency and post-stabilization services; and
- How afterhours and emergency coverage is provided and the rules for post-stabilization care.
- The structure and operation of the Arizona Department of Health Services/Division of Behavioral Health Services (ADHS/DBHS) or ADHS/DBHS contractors (applicable to all AHCCCS members); and,
- Physician incentive plans (including the plan’s effect on the use of referral services, the types of compensation arrangements the plan uses, whether stop-loss insurance is required and a summary of the member survey results).
You also have the right to request an updated member handbook annually and a current Provider Directory at any time and at no cost to you. The Provider Directory will contain the name, location, telephone number, and hours of operation for all:
- Current providers in your service area;
- Providers that speak a language other than English and the language(s) spoken;
- Providers in your service area that are not accepting new members;
- Providers and hospitals that offer emergency and post-stabilization services; and
- Urgent cares and hospitals that offer afterhours, weekend, and holiday services.
To request any of this information, contact 1-866-495-6738 or TTY/TDD 1-877-613- 2076.
Your Responsibilities as a Member
- Respect the doctors, pharmacists, staff, and people providing services to you.
- Share Information
- Show your member ID card or identify yourself as a Cenpatico-IC member to health care providers before getting services. If you have other insurance in addition to Cenpatico-IC, show your doctor or pharmacist both insurance ID cards.
- If you do not understand your health condition or treatment plan, ask your doctor to explain.
- Tell your doctors and/or your case manager about any other insurance you may have and apply for other benefits you may be eligible for.
- Give your doctors and case manager all the facts about your health problems, past illnesses, hospital stays, all medications, shots and other health concerns.
- Notify Cenpatico-IC any time you feel a provider or another member is not using health plan benefits correctly.
- Report changes like your family size, address, telephone number and/or assets, and other matters that could affect your eligibility to your case manager, Cenpatico-IC Member Services, and/or the interviewer at the office where you applied for AHCCCS.
- Participate in Recovery
- Know the name of your doctors and/or your case manager.
- Participate in creating your Service Plan.
- Follow the instructions that you and your doctors have agreed on, including the instructions of nurses and other health care professionals.
- Schedule appointments during office hours when possible, instead of using urgent or emergency care.
- Keep appointments and come on time. Call your PCP’s office ahead of time when you cannot keep your appointments. You may also call Cenpatico-IC Member Service for assistance with appointments at: 1-866-495-6738 or TTY/TDD 1-877-613- 2076
Title 19/21 eligible persons are also responsible for:
- Protecting your identification (ID) card;
- Not misusing your ID card, including loaning, selling or giving your card to others, which may result in the loss of your eligibility or legal action; and
- Keeping, not discarding your ID card.
Physical Health Rights and Responsibilities
Member Rights and Responsibilities
You will find a copy of the Privacy Rights notice in your welcome packet. The notice tells how we use your records, including information that identifies you, for health plan activities and to pay for your services. It also tells how you can look at your records, get a copy of them, or change them. Your health care information will be kept private and confidential, and will be given out only with your permission or if allowed by law. In addition to the Behavioral Health Member Rights and Responsibilities listed in Section I, you also have rights and responsibilities specific to your medical care. These are listed below. It is important that you read and understand each one. If you have questions, please call Member Services at: 1-866-495-6738 or TTY/TDD 877-613-2076.
Your Rights as a Member
Information you can get:
- The name of your Primary Care Physician (PCP) and/or case manager.
- Changes to your services or what to do if your PCP leaves Cenpatico-IC.
- You can choose a Cenpatico-IC PCP to coordinate your health care.
- You can change your PCP if you need to.
- You can be informed about which procedures you will have and who will do them.
- You can have a female in the room for breast and pelvic exams.
- You will be told in writing by Cenpatico-IC when any of your health care services requested by your PCP are reduced, suspended, terminated, or denied. You must follow the instructions in your notification letter.
- Know how Cenpatico-IC evaluates new technology to include as a covered service.
- You will have your protected health information kept private, unless there is a reason to share your health information (see page 26 for limits to confidentiality).
Emergency Care and Specialty Services
- You may get behavioral health services without the approval of your PCP or Cenpatico-IC.
- You can see a specialist with a referral from your PCP.
- You can refuse care from a doctor you were referred to and ask for a different doctor.
- You have a right to talk to health care professionals privately.
Your Responsibilities as a Member
- Protect your member ID card. Do not lose it or share it with anyone.
- Bring your child’s shot record to all your child’s PCP visits.