Your Rights as an AmeriHealth Caritas Ohio Member

AmeriHealth Caritas Ohio complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, ethnicity, national origin, age, disability, sex, pregnancy, religion, National Guard or Veteran’s status, sexual orientation, and gender identity or expression or any other status protected by federal or state law.

AmeriHealth Caritas Ohio is committed to complying with all applicable requirements under federal and state law and regulations pertaining to member privacy and confidentiality rights.

As a member of AmeriHealth Caritas Ohio, you have a right:

  • To make recommendations about the rights and responsibilities of AmeriHealth Caritas Ohio members.
  • To receive all information and services that AmeriHealth Caritas Ohio must provide.
  • To receive all information about AmeriHealth Caritas Ohio’s services, practitioners, and providers. 
  • To be treated with respect and with regard for your dignity and privacy.
  • To be sure that your medical record information will be kept private.
  • To be given information about your health. 
    • This information may also be available to someone who you have legally approved to have the information or who you have said should be reached in an emergency when it is not in the best interest of your health to give it to you.
  • To discuss medically necessary treatment options for your condition(s), no matter the cost or benefit coverage.
  • To participate with providers in making decisions relating to your health care.
  • To be able to take part in decisions about your health care as long as the decisions are in your best interest.
  • To get information on any medical care treatment, given in a way that you can follow.
  • To be sure others cannot hear or see you when you are getting 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 regulations.
  • To ask, and get, a copy of your medical records, and to be able to ask that the record be changed/corrected if needed.
  • To say “yes” or “no” to having any information about you given out unless AmeriHealth Caritas Ohio must by law.
  • To say no to treatment or therapy. If you say no, the provider or AmeriHealth Caritas Ohio must talk to you about what could happen, and they must put a note in your medical record about it.
  • To file an appeal, a grievance (complaint) or state fair hearing.
  • To get help free of charge from AmeriHealth Caritas Ohio and its providers if you do not speak English or need help in understanding information.
  • To get all written member information from the AmeriHealth Caritas Ohio:
    • At no cost to you.
    • In the prevalent non-English languages of members in the AmeriHealth Caritas Ohio service area.
    • In other ways, to help with the special needs of members who may have trouble reading the information for any reason.   
  • To get help with sign language if you are hearing impaired. 
  • To be told if the health care provider is a student and to be able to refuse their care.
  • To be told of any experimental care and to be able to refuse to be part of the care.
  • To make advance directives (a living will).
  • To file any complaint about not following your advance directive with the Ohio Department of Health.
  • To change your primary care provider (PCP) to another PCP in the AmeriHealth Caritas Ohio’s network at least monthly. AmeriHealth Caritas Ohio must send you something in writing that says who the new PCP is by the date of the change.
  • To be free to carry out your rights and know that the AmeriHealth Caritas Ohio, the AmeriHealth Caritas Ohio providers or the Ohio Department of Medicaid will not hold this against you.
  • To know that the AmeriHealth Caritas Ohio must follow all federal and state laws, and other laws about privacy that apply.
  • To choose the provider that gives you care whenever possible and appropriate.
  • If you are a female, to be able to go to a women’s health provider in the AmeriHealth Caritas Ohio network for covered women’s health services.
  • To get a second opinion from a qualified provider in the AmeriHealth Caritas Ohio’s network. If a qualified provider is not able to see you, AmeriHealth Caritas Ohio must set up a visit with a provider not in our network.
  • To get information about AmeriHealth Caritas Ohio from us.
  • To contact the Ohio Department of Medicaid and/or the United States Department of Health and Human Services Office of Civil Rights at the addresses below with any complaint of discrimination based on race, ethnicity, religion, gender, gender identity, sexual orientation, age, disability, national origin, military status, genetic information, ancestry, health status, or need for health services.

The Ohio Department of Medicaid
Office of Human Resources, Employee Relations
P.O. Box 182709
Columbus, OH 43218-2709

Fax: 614-644-1434

Office for Civil Rights
United States Department of Health and Human Services
233 North Michigan Avenue, Suite 240
Chicago, IL 60601
Phone: 312-886-2359 (TTY 312-353-5693)

Help from Member Services

There is someone to help you at Member Services. Just call Member Services at 1-833-764-7700 (TTY 1-833-889-6446), 24 hours a day, seven days a week.

  • In case of a medical emergency, call 911.
  • You can call Member Services to get help anytime you have a question. You may call us to choose or change your primary care provider (PCP), to ask about benefits and services, to get help with referrals, to replace a lost ID card, to report the birth of a new baby, or ask about any change that might affect you or your family’s benefits.
  • If you are or become pregnant, your child will become part of AmeriHealth Caritas Ohio on the day your child is born. You should call your plan and your local Department of Social Services right away if you become pregnant and let us help you to choose a PCP for both you and your newborn baby before he or she is born.
  • If English is not your first language (or if you are reading this on behalf of someone who doesn’t read English), we can help. We want you to know how to use your health care plan, no matter what language you speak. Just call us and we will find a way to talk with you in your own language. We have a group of people who can help.
  • For people with disabilities: If you use a wheelchair or have trouble hearing or understanding, call us if you need extra help. If you are reading this on behalf of someone who is blind, deaf-blind, or has difficulty seeing, we can also help. We can tell you if a PCP’s office is wheelchair accessible or is equipped with special communications devices. Also, we have services like:
    • TTY machine. Our TTY phone number is 1-833-889-6446.
    • Information in large print
    • Help in making or getting to appointments
    • Names and addresses of providers who specialize in your condition

Auxiliary aids and services

If you have a hearing, vision, or speech disability, you have the right to receive information about your health plan, , and services in a format that you can understand and access. AmeriHealth Caritas Ohio provides free aids and services to help people communicate effectively with us, like:

  • A TTY machine. Our TTY phone number is 1-833-889-6446.
  • Qualified American Sign Language interpreters
  • Closed captioning
  • Written information in other formats (like large print, audio, accessible electronic format and other formats)

These services are available to members with disabilities at no cost. To ask for aids or services, call Member Services at 1-833-764-7700 (TTY 1-833-889-6446), 24 hours a day, seven days a week.

If you believe that AmeriHealth Caritas Ohio failed to provide these services, you can file a complaint. To file a complaint or to learn more, call Member Services at 1-833-764-7700 (TTY 1-833-889-6446), 24 hours a day, seven days a week.

Other ways we can help

If you have basic questions or concerns about your health, you can call our Nurse Advice Line at 1-833-625-6446 (TTY 1-833-889-6446) at any time, 24 hours a day, seven days a week. You can get information on when to go to your PCP or ask questions about symptoms or medicines.

If you are experiencing emotional or mental pain or distress, call us the Behavioral Health Crisis Line at 1-800-720-9616 at any time, 24 hours a day, seven days a week, to speak with someone who will listen and help. We are here to help you with problems like stress, depression, or anxiety. We can connect you to the support you need to help you feel better. If you are in danger or need immediate medical attention, call 911.