Member Rights

You have the right to:

  • Know about AmeriHealth Caritas Louisiana health plan and its health care providers.
  • Get information about AmeriHealth Caritas Louisiana, its health care providers, and member rights and responsibilities.
  • Get information and know about your benefits and services.
  • Get information about the cost of health care services.
  • Have your medical records and care kept confidential.
  • Expect that AmeriHealth Caritas Louisiana will give you a copy of its Notice of Privacy Practices without your requesting it.
  • Privacy of your personal and health information.
  • Approve or deny the release of identifiable medical or personal information, except when the release is required by law.
  • Be treated with dignity and respect by your health care providers and AmeriHealth Caritas Louisiana.
  • Talk with your health care provider about treatment plans.
  • Get information from a health care provider on available treatment options and alternatives, given in a way you understand.
  • Talk to your health care provider about the kinds of care you can choose to meet your medical needs regardless of cost or benefit coverage.
  • Voice complaints about and/or appeal decisions made by AmeriHealth Caritas Louisiana and its health care providers and to receive information about how to do so.
  • File for a state fair hearing and information about how to do so.
  • Get materials and/or help that is easily understood and in alternate languages and formats, if necessary.
  • Make an "advance directive."
  • Ask for and receive a copy of your medical records in accordance with applicable federal and state laws, and ask that they be amended or corrected.
  • Be given an opportunity to make suggestions for changes in AmeriHealth Caritas Louisiana's policies and procedures.
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation, as specified in the Federal regulations on the use of restraint and seclusion.
  • Be a part of the decisions about your health care, including the right to refuse treatment. Your decision to do so will not negatively affect the way you are treated by AmeriHealth Caritas Louisiana, its health care providers or the Louisiana Department of Health (LDH).
  • Ask that any communication that has protected health information in it from AmeriHealth Caritas Louisiana be sent to you by alternative means or to an alternative address.
  • Ask that AmeriHealth Caritas Louisiana amend certain protected health information.
  • Ask for a list of disclosures of protected health information.
  • To receive health care services that are accessible, are comparable in amount, duration and scope to those provided under Medicaid Fee-for-Service and are sufficient in amount, duration and scope to reasonably be expected to achieve the purpose for which the services are furnished.
  • To receive services that are appropriate and are not denied or reduced solely because of diagnosis, type of illness or medical condition.
  • To receive assistance from both LDH and the enrollment broker in understanding the requirements and benefits of the plan.
  • To receive oral interpretation services free of charge for all non-English languages, not just those identified as prevalent.
  • To be notified that oral interpretation is available and how to access those services.
  • As a potential member, to receive information about the basic features of the plan program; which populations may or may not enroll in the program and the plan’s responsibilities for coordination of care in a timely manner in order to make an informed choice.
  • To report any marketing violations made by AmeriHealth Caritas Louisiana to LDH by calling the Louisiana Medicaid customer service hotline at 1-888-342-6207 and asking for a marketing complaint form.
  • To receive information on the plan's services
  • To receive a complete description of disenrollment rights at least annually.
  • To receive notice of any significant changes in core benefits and services at least 30 days before the intended effective date of the change.
  • To receive detailed information on emergency and after-hours coverage.
  • To receive the plan's policy on referrals for specialty care and other benefits not provided by the member's PCP.
  • To exercise these rights without adversely affecting the way the plan, its providers or LDH treat the member.

For more information or to make suggestions, please call Member Services.

Members