Members Rights and Responsibilities

Our Commitment to You

Our goal is to provide high-quality medical care and advanced medical treatment. We also promise to listen, treat you with respect, and understand your individual needs. Members have rights and responsibilities. The following is a description of your rights and responsibilities.

Member Rights:

  1. You have the right to complain to us about B – UFC/ALTCS and/or care provided.
  2. You have the right to ask for information on the structure and operation of B – UFC/ALTCS or its subcontractors.
  3. You have the right to information about B – UFC/ALTCS's services, health care providers, admission, transfer, discharge, billing policies, and members' rights and responsibilities.  
  4. You have the right to be treated fairly regardless of race, ethnicity, national origin, religion, gender, age, behavioral health condition (intellectual) or physical disability, sexual preference, genetic information, or ability to pay.
  5. You can be told about Physician Incentive Plans that affect referral services.
  6. You have the right to know that B – UFC/ALTCS is required to participate in a stop-loss insurance program.
  7. You can be told the types of plans B – UFC/ALTCS uses for compensation.
  8. You can get a summary of member survey results.
  9. You will get care that meets your needs in a way that doesn't judge race, gender, religious beliefs, values, language, how much a person is able to do, age, physical or mental disability, or ability to pay.
  10. B – UFC/ALTCS and their participating providers will safeguard the confidentiality of your information as required by state and federal law. This includes your B – UFC/ALTCS specific record set and your medical (care) records kept by your provider(s). B – UFC/ALTCS specific record set: The law states that you have the right to read or get copies of your medical claim history, pharmacy claim history, grievance and appeals documents, and your B – UFC/ ALTCS phone call records at no cost to you from B – UFC/ALTCS. To get those records, B – UFC/ALTCS must have the request in writing. You may make this request by calling our Customer Care Center or asking your B – UFC/ALTCS Case Manager. You will be sent an authorization form to complete and will return it to the Compliance Team with a copy of a picture ID so we can make sure we only send your records to you or someone you allow to get your records, or verification from the B – UFC/ALTCS Case Manager for you or your authorized representative. You can receive your records in paper form or by email (encrypted or not) if you prefer. There is some level of risk that a third party could get your Protected Health Information (PHI) without your consent when electronic media or email is unencrypted. We are not responsible for unauthorized access to unencrypted media or email or for any risks (e.g., Virus) potentially introduced to your computer/device when receiving PHI in electronic format or email.
  11. Coordination of care with schools and state agencies may occur within the limits of applicable regulations.
  12. You have the right to a second opinion from a qualified health care professional within B – UFC/ALTCS's network. If an in-network second opinion is not available, you have the right to have a second opinion arranged outside of the B – UFC/ALTCS network at no cost to you.
  13. You can receive information on available treatment options and alternatives in a manner that is appropriate to your condition and is easy to understand.
  14. You can make Advance Directives and appoint someone to make health care decisions for you. You or your representative can change your Advance Directives at any time. You have the right to be provided with information about formulating Advance Directives (B – UFC/ALTCS must ensure involvement by you or your representative in decisions to withhold resuscitative services, or to forgo or withdraw life-sustaining treatment within the requirements of Federal and State law with respect to Advance Directives [42 C.F.R. 438.6]). For members in a HCBS or a behavioral health residential setting that have completed an Advance Directive, the document must be kept confidential but be readily available. For example: in a sealed envelope attached to the refrigerator.
  15. MEDICAL CARE RECORDS: The law states that you have the right to read, or annually request and get a copy of your medical care records at no cost to you (from any provider who provides care for you ). Contact your provider to ask to see or get a copy of your medical record. You will receive a response to your request within 30 days. However, your right to access medical care records may be denied if the information is psychotherapy notes, compiled for, or in a reasonable anticipation of a civil, criminal or administrative action, protected health information subject to the Federal Clinical Laboratory Improvement Amendments of 1988 or exempt pursuant to 42 CFR 493.3(a)(2), or a licensed health care professional has found that receiving or accessing your records would likely endanger the life or safety of you or another person. If your access is denied for some of these reasons, you have the right to have the denial reviewed. Providers must allow you to review your records by reading them at the provider's office or giving you a copy or both. If your provider does not give you the records or does not respond to your request within 30 days, please contact B – UFC/ALTCS Customer Care Center at (833) 318-4146 for help.
  16. B – UFC/ALTCS must reply to your request for medical records no later than thirty (30) days. after receipt of your request. If B – UFC/ ALTCS is unable to take action within thirty (30) days, B –UFC/ ALTCS may take extra 30 days. B – UFC/ALTCS will let you know the reason for the delay and the date the request will be completed. This response will either be a copy of your records in the manner you requested, permission for you to view your records on-site, or a reason for denying your request. If a request is denied, in whole or in part, B – UFC/ALTCS must give you a reason for the denial and your rights to a review o f the denial of access.
  17. You have the right to ask any provider who provides care for you to amend or correct your medical care records that are kept by your treating provider. You may initiate this request by calling our Customer Care Center and your response will be required in writing.
  18. You have the right to be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
  19. You have the right to the information needed to help you make informed decisions.
  20. You have the right to receive information on beneficiary and plan information
  21. You have the right to participate in treatment decisions. You have the right to help in decision making about your health care and Advance Directives (decisions about what kind of care you would like to receive if you become unable to make medical decisions). This includes the right to refuse treatment.
  22. You will be treated with respect and with due consideration for your dignity and privacy. We understand your need for privacy and confidentiality including protection of any information that identifies you.
  23. You have the right to have a list of available providers, including those who speak a language other than English and access to a sign language interpreter for the hearing impaired.
  24. You have the right to have language interpretive services from a provider who speaks your primary language, if other than English.
  25. You have the right to written materials in alternate formats.
  26. You have the right to seek Emergency Service at any hospital or other Emergency Room facility (in or out of network).
  27. You will be treated in a safe, supportive and smoke-free environment.
  28. You have the right to choose your PCP within the B – UFC/ALTCS network.
  29. You have the right to help in decision making about your health care and Advance Directives (decisions about what kind of care you would like to get if you become unable to make medical decisions).
  30. You or someone who represents you can take part in resolving problems about your health care decisions.
  31. You have the right to involve family members or other people you choose to help you make decisions about your treatment plans.
  32. You have the right to ask for a copy of the Notice of Privacy Practices at no cost to you. The notice describes B – UFC/ALTCS's privacy practices and how we use health information about you and when we may share that health information with others.
  33. You have the right to request the criteria that decisions are based on.
  34. American Indian members are able to receive health care services from any Indian Health Service provider or tribally owned and/or operated facility at any time.
  35. The member has the right to exercise his or her rights and that the exercise of those rights shall not adversely affect service delivery to the member [42 CFR 438.100(c)].
  36. The member has the right for critical services. This include attendant care, personal care, homemaker and respite as authorized by the case manager. A gap in critical services happens when an agency authorized to provide the care is not able to provide the total scheduled services. When a caregiver cancels, does not show up at the scheduled time, or has to leave early, you should immediately contact the agency who scheduled the caregiver. They can offer you another caregiver to provide the care. If you do not want another caregiver in the same day, it is still important to notify the agency directly. You have a right to a replacement caregiver within 2 hours. If the gap is not resolved, you should contact your case manager for help. In the event the gap occurs after hours on holidays or weekends, call the after-hours number at (833) 318-4146. If needed, you can also file a grievance by calling our Customer Care Center. If you need further help resolving a gap in critical service, you can call AHCCCS at (800) 218-7509.