Member Rights and Responsibilities
It is the responsibility of Blue Cross and Blue Shield of Kansas (BCBSKS) and its contracting providers to treat you and/or members of your family in a manner that acknowledges and supports your basic human rights.
As a BCBSKS member, you have the following rights and responsibilities:
|You have the right to…||You have the responsibility to…|
|Considerate and courteous care, with respect for personal privacy and dignity.||Treat BCBSKS personnel respectfully and courteously as partners in good health care.|
|Select your own physician.||Develop a physician-patient relationship based on trust and cooperation.|
|Request a directory of BCBSKS contracting providers.||Understand the benefit differences when utilizing out of network providers.|
|Participate in the health care process with the professionals who can help you take charge of your health and you have the right to say no to any treatment.||Maintain your health and prevent illness by making positive health choices and seeking appropriate care when needed.|
|Reasonable access to appropriate medical services.||Keep scheduled appointments or give adequate notice of delay or cancelation and to notify BCBSKS if you are unable to access appropriate medical services.|
|Receive the benefits of your BCBSKS membership and to be informed of available services, as well as where, when, and how you can obtain these services.||Read all BCBSKS materials carefully and immediately upon your enrollment and to ask questions when necessary.|
|Notify BCBSKS promptly of any changes affecting your membership and to remit premiums by the due date.|
|Receive assistance when language barriers exist between you or a member of your family and BCBSKS or a provider of service.||Advise your physician and/or BCBSKS when you require assistance due to a language barrier.|
|Your personal information and health records to be kept confidential except when disclosure is required by law.||Help maintain accurate and current records by being honest and complete when providing information to BCBSKS and/or health care professionals.|
|Express a complaint and to receive an answer to the complaint within a reasonable period of time.||Express your concerns or complaints in a constructive manner to the appropriate people at BCBSKS.|
|Appeal adverse benefit decisions and to receive the documentation used to make the decision.||Make timely appeals in the proscribed manner.|
|Receive prompt and accurate claims payment.||Make payment for copayments, deductibles and coinsurance as listed in your certificate.|
These protections apply to patients who have BlueCare plans under the Affordable Care Act:
- Annual and lifetime dollar limits to coverage of essential benefits have been removed. (Essential benefits include doctor and specialist visits, home and hospice services, emergency services, hospitalization, preventive and wellness services, chronic disease management, laboratory services, prescription drugs, maternity and newborn care, pediatric services, mental health and substance use disorder services, and rehabilitative services and devices. Non-essential benefits include things like adult dental care.)
- You will be able to get health insurance in spite of pre-existing medical conditions (medical problems they have before getting insurance).
- You have the right to an easy-to-understand summary of benefits and coverage.
- Young adults are able to stay on a parent’s policy until age 26 if they meet certain requirements.
- You are entitled to certain preventive screening without paying extra fees or co-pays.
- If your plan denies payment for a medical treatment or service, you must be told why it was refused, and how to appeal (fight) that decision.
- You have the right to appeal the payment decisions of private health plans (called an “internal appeal”). You also have the right to a review by an independent organization (called an “outside review”) if the company still doesn’t want to pay.
- Larger insurance companies must spend 80 to 85% of their premiums on health care and improvement of care rather than on salaries, overhead, and marketing.
- If you made an honest mistake on your insurance application, health insurance companies will no longer be able to rescind (take back) your health coverage after you get sick. (They can still cancel coverage if you don’t pay premiums on time, if you lied on your application form, or if they no longer offer plans in your region.)
- If a company does cancel your coverage, they must give you at least 30 days’ notice.
- Premium increases of more than 10% must be explained and clearly justified.
- Back -