At a minimum, members have the following basic rights:
- To receive information about Carelon Medical Benefits Management and its services.
- To be treated with respect.
- To participate with health practitioners in making decisions about their healthcare.
- To a candid discussion of appropriate and medically necessary treatment options for their conditions, regardless of cost or benefit coverage.
- To have the privacy of their confidential information protected.
- To have authorized representatives act on their behalf.
- To a full and fair process for resolving their disputes.
- To voice or file complaints and appeals about the organization or the care it provides. For assistance, members should call the Member Services number on their health plan ID card. Complaints involving Carelon Medical Benefits Management services will be brought to Carelon Medical Benefits Management's attention by the member’s health plan.
It’s important we treat you fairly.
That’s why we follow federal civil rights laws in our activities. We don’t discriminate, exclude people, or treat them differently on the basis of race, color, national origin, sex, age or disability.
For people with disabilities, we offer free aids and services. For people whose primary language isn’t English, we offer free language assistance services through interpreters and other written languages. If you are interested in any of these services, please call the Member Services number on your health plan ID card for assistance (TTY/TDD: 711)
If you believe that we failed to offer these services or discriminated based on race, color, national origin, age, disability, or sex, you can file a complaint, also known as a grievance.
- You can file a complaint with the U.S. Department of Health and Human Services online. Click here
- Complaint forms are also available at the U.S. Department of Health and Human Services. Click here
To help ensure the quality, safety, and efficiency of their care, members are required to observe the following responsibilities:
- Supply accurate information (to the extent possible) needed to provide care.
- Follow instructions for care that they have agreed on with their health practitioners.
- Understand their health problems and participate with their providers in developing mutually agreed-upon treatment goals to the degree possible.
- Provide feedback to Member Services and/or their health care provider, as appropriate.
For assistance or questions about Carelon Medical Benefits Management, members should call the Member Services number on their health plan ID card.
