Rights & Responsibilities

Member Rights

As a member of CareSource you have the following rights:

  • To get information about CareSource, its services, its providers, and member rights and duties.
  • To get all services that CareSource must provide.
  • To be treated with respect and with regard for your dignity and privacy.
  • To be sure your personal information and medical records will be kept private.
  • To be given information about your health. This information may also be available to someone legally authorized to have the information. It may also be given to someone the member has said should be reached in an emergency.
  • To discuss information on any appropriate or medically necessary treatment options and alternatives for your condition, regardless of cost or benefit coverage, in a manner appropriate to your condition and your ability to understand.
  • To be able to participate with providers in making decisions about your health care including the right to refuse treatment.
  • To get information about any medical care, given in a way that you can understand.
  • To be sure that others cannot hear or see you while they are getting medical care.
  • Be free from any form of restraint or seclusion as a means of coercion, discipline, convenience or retaliation, as specified in federal regulations on the use of restraints and seclusion.
  • To ask for and receive a copy of your medical records and to be able to ask that the record be changed/corrected if needed in accordance with federal privacy law.
  • The right to request at any time, information on our physician incentive plan, marketing materials or information about the structure and operation of CareSource.
  • To be able to say yes or no to having any information about you given out unless CareSource has to by law.
  • To be able to say no to treatment or therapy. If you or your parent/guardian say no, the doctor or CareSource must talk to you about what could happen and a note must be placed in your medical record about refusing care.
  • To freely be able to file an appeal, a grievance (complaint), or request a state fair hearing and that the exercise of these rights will not adversely affect the way they are treated.
  • To be able to get all written member information from CareSource:
    • At no cost to you.
    • In the prevalent non-English languages of members in CareSource’s service area.
    • In other formats, to help with special needs if you have trouble reading the information for any reason.
  • To be able to get help free of charge from CareSource and its providers if you do not speak English or need help in understanding information.
  • To be able to get help with sign language if you are hearing impaired.
  • To be told if the health care provider is a student and to be able to refuse their care.
  • To get information on treatment options in a way you or your parent/guardian can understand.
  • To make Advance Directives.
  • To be free to carry out your rights and know that CareSource, our providers or the Georgia Department of Community Health will not hold this against you.
  • To know that CareSource must follow all federal and state laws, and other laws about privacy that apply.
  • To choose the provider that gives you care whenever possible and appropriate.
  • Female members have the right to see a women’s health provider for covered women’s health services.
  • To be able to get a second opinion from a qualified network provider. If a qualified provider is not available, CareSource must set up a visit with a provider not in the CareSource network.
  • To go out of network for care if CareSource is unable to provide a covered service in our network.
  • To get information about CareSource from CareSource.
  • To make suggestions about CareSource’s member rights and responsibility policy.
  • To only be responsible for cost sharing in accordance with federal and state regulations and contracts.
  • To not be held liable for CareSource’s debts in the event of insolvency.
  • To not be held liable for covered services provided to you for which DCH or CareSource does not pay the health care provider that furnishes the services.
  • To not be held liable for payments of covered services furnished under a contract, referral, or other arrangement to the extent that those payments are in excess of the amount they would owe if CareSource provided the services directly.

Member Responsibilities

  • Use only approved providers.
  • Keep doctor appointments; be on time, and call 24 hours before the scheduled appointment to cancel.
  • Follow the advice and instructions (steps) for care they have agreed to with your doctors and other health care providers.
  • Always carry your ID card. Show it when getting care.
  • Never let anyone else use your ID card.
  • Tell your county caseworker and CareSource of a change in phone number or address.
  • Contact your PCP after going to an urgent care center or after getting physical or behavioral health care.
  • Let CareSource and the county caseworker know if you have other health insurance coverage.
  • Provide the information that CareSource and your health care providers need, to the extent possible, to provide care.
  • Tell us of suspected fraud as described in the Fraud, Waste and Abuse section of this handbook.
  • Understand as much as possible about your health issues and take part in reaching goals agreed to with your health care provider.

Member Services: 1-855-202-0729 (TTY: 1-800-255-0056 or 711), Monday – Friday 7 a.m. – 7 p.m.