Members Rights & Responsibilities

Aetna Better Health members have these rights:

  • To be treated with respect, giving due consideration to the Member’s right to privacy and the need to maintain confidentiality of the Member’s medical information.
  • To be provided with information about the plan and its services, including Covered Services.
  • To be able to choose a Primary Care Provider within Aetna’s network.
  • To participate in decision making regarding their own health care, including the right to refuse treatment.
  • To voice grievances, either verbally or in writing, about the organization or the care received.
  • To receive oral interpretation services for their language.
  • To formulate advance directives.
  • To have access to family planning services, Federally Qualified Health Centers, Indian Health Service Facilities, sexually transmitted disease services and Emergency Services outside the Aetna’s network pursuant to the federal law.
  • To request a State Hearing, including information on the circumstances under which an expedited hearing is possible.
  • To have access to, and where legally appropriate, receive copies of, amend or correct their Medical Record.
  • To disenroll upon request.
  • To access Minor Consent Services.
  • To receive written Member informing materials in alternative formats (including Braille, large size print, and audio format) upon request and in a timely fashion appropriate for the format being requested and in accordance with W & I Code Section 14182 (b)(12).
  • To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.
  • To receive information on available treatment options and alternatives, presented in a manner appropriate to the Member’s condition and ability to understand.
  • To receive a copy of his or her medical records, and request that they be amended or corrected, as specified in 45 CFR §164.524 and 164.526.
  • Freedom to exercise these rights without adversely affecting how they are treated by Aetna, providers, or the State.

Aetna Better Health members have these responsibilities:

  • Read this Evidence of Coverage. It tells you about our services, and how to file a grievance or appeal.
  • Use your ID cards when you go to health care appointments or get services and do not let anyone else use your cards.
  • Know the name of your PCP and your care manager if you have one.
  • Know about your health care and the rules for getting care.
  • Tell the Plan and DHCS when you make changes to your address, telephone number, family size, moving out of state, employment change and other information that might affect enrollment.
  • Understand your health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible.
  • Be respectful to the health care providers who are giving you care.
  • Schedule your appointments, be on time, and call if you are going to be late to or miss your appointment. If you need to cancel an appointment, it must be done at least twenty-four (24) hours before your scheduled visit.
  • Use the emergency room for true emergencies only.
  • Give your health care providers all the information they need.
  • Tell the Plan and DHCS about your concerns, questions or problems.
  • Ask for more information if you do not understand your care or health condition.
  • Follow your health care provider’s advice.
  • Schedule wellness check-ups. Members under twenty-one (21) years of age need to follow the Early Periodic Screening Diagnosis and Treatment (EPSDT) schedule.
  • Get care as soon as you know you are pregnant. Keep all prenatal appointments.
  • Tell us about any other insurance you have.
  • Tell us if you are applying for or get any other health care benefits.
  • Bring shot records to all appointments for children under 18 years old.
  • Give your doctor a copy of your living will or advance directive.
  • Keep track of the cost-sharing amounts you pay.