Rights & Responsibilities
Your Membership Rights
As a member of Humana – CareSource you have the following rights:
- To receive all services that the plan must provide and to get them in a timely manner.
- To get timely access to care without any communication or physical access barriers.
- To have reasonable opportunity to choose the provider that gives you care whenever possible and appropriate.
- To choose a primary care provider (PCP) and change to another PCP in Humana – CareSource’s network. We will send you something in writing that says who the new PCP is when you make a change.
- To be able to get a second opinion from a qualified provider in or out of our network. If a qualified provider is not able to see you, we must set up a visit with a provider not in our network.
- To get timely access and referrals to medically indicated specialty care.
- To be protected from liability for payment.
- To receive information about your health. It may also be given to someone you have legally approved to have the information. Or it may be given to someone you said should be reached in an emergency when it is not in the best interest of your health to give it to you.
- To ask questions and get complete information about your health and treatment options in a way that you can follow. This includes specialty care.
- To have a candid discussion of any appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage.
- To take an active part in decisions about your health care unless it is not in your best interest.
- To say yes or no to treatment or therapy. If you say no, the doctor or Humana – CareSource must talk to you about what could happen. They will put a note in your medical record about it.
- To be treated with respect, dignity, privacy, confidentiality, and nondiscrimination.
- To have access to appropriate services and not be discriminated against based on health status, religion, age, gender or other bias.
- To be sure that others cannot hear or see you when you get medical care.
- To be free from any form of restraint or seclusion used as a means of force, discipline, ease, or revenge as specified in federal laws.
- Any American Indian enrolled with Humana – CareSource eligible to receive services from a participating I/T/U provider or a I/T/U primary care provider shall be allowed to receive services from that provider if part of Humana – CareSource’s network. I/T/U stands for Indian Health Service, Tribally Operated Facility/Program, and Urban Indian Clinic.
- To get help with your medical records in accordance with federal and state laws that apply.
- To be sure that your medical records will be kept private.
- To ask for and receive one free copy of your medical records and to be able to ask that your health records be changed or corrected if needed. More copies are available to members at cost.
- To say yes or no to having information about you given out unless Humana – CareSource has to provide it by law.
- To be able to get all written member information:
- At no cost to you
- In the most common non-English languages of members in our service area
- In other ways to help with the special needs of members who may have trouble reading the information for any reason
- To be able to get help from us and our providers if you do not speak English or need help to understand information. You can get the help free of charge.
- To get help with sign language if you are hearing impaired.
- To be told if a health care provider is a student and be able to refuse his or her care.
- To be told if care is experimental and be able to refuse to be part of the care.
- To know that Humana – CareSource must follow all federal, state and other laws about privacy that apply.
- If you are a female, to be able to go to a woman’s health provider in our network for covered woman’s health services.
- To file an appeal or grievance (complaint) or request a state fair hearing. You can also get help with filing an appeal or grievance. You can ask for a state fair hearing from Humana – CareSource and/or the Department for Medicaid Services (DMS). See the member handbook (English or Spanish) for more details.
- To make advance directives, such as a living will.
- To contact the Office of Civil Rights at the address below with any complaint of discrimination based on race, color, religion, sex, sexual orientation, age, disability, national origin, veteran’s status, ancestry, health status or need for health services.
Office for Civil Rights
Sam Nunn Atlanta Federal Center, Suite 16T70
61 Forsyth Street, S.W.
Atlanta, GA 30303-8909
1-800-368-1019 or TTY: 1-800-537-7697
- You have the right to get help with sign language if you are hearing impaired.
- To receive information about Humana – CareSource, our services, our practitioners and providers and member rights and responsibilities.
- To make recommendations to our member rights and responsibility policy.
- If Humana – CareSource is unable to provide a necessary and covered service in our network, we will cover these services out of network. We will do this for as long as we are unable to provide the service in network. If you are approved to go out of network, this is your right as a member. There is no cost to you.
- To be free to carry out your rights and know that Humana – CareSource or our providers will not hold this against you.
- Report suspected fraud and abuse.
As a member of Humana – CareSource you must also be sure to:
- Know your rights.
- Follow Humana – CareSource and Kentucky Medicaid policies and procedures.
- Know about your service and treatment options.
- Take an active part in decisions about your health and care and lead a healthy lifestyle.
- Understand as much as possible about your health issues. Take part in reaching goals that you and your health care provider agree upon.
- Let us know if you suspect health care fraud or abuse.
- Let us know if you are unhappy with us or one of our providers.
- If you file an appeal with us, put the request in writing.
- Use only approved providers.
- Keep scheduled doctor visits. Be on time. If you have to cancel, call 24 hours in advance.
- Follow the advice and instructions for care you have agreed upon with your doctors and other health care providers.
- Always carry your ID card. Show it when receiving services.
- Never let anyone else use your ID card.
- Let us know of a change in your phone number, address or family size, including births and deaths. It is also a good idea to tell your local Department for Community Based Services (DCBS) about these changes. To find your local DCBS office, go to https://prdweb.chfs.ky.gov/Office_Phone/index.aspx.
- Call your PCP after going to an urgent care center, after a medical emergency, or after getting medical care outside of Humana – CareSource’s service area.
- Let Humana – CareSource and the DCBS know if you have other health insurance coverage.
- Provide the information that Humana – CareSource and your health care providers need in order to provide care for you.
We will tell you about changes to our member rights and responsibilities on our website or in newsletters.