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Eployer Benfits at Carolina Behavioral Health Alliance

Statement of Enrollee Rights and Responsibilities

ENROLLEE RIGHTS

Enrollees whose behavioral health benefits are managed by Carolina Behavioral Health Alliance (CBHA) have the right to:

  1. Be treated with courtesy, respect and dignity without regard to race, gender, cultural background, religion or other protected classifications.
  2. A clear and understandable explanation of benefit plans and how to access behavioral health services.
  3. Request and receive information about CBHA and its services.
  4. Request and receive information about how CBHA determines medical necessity and authorizes behavioral health services.
  5. Request access to inspect and copy your protected health information and to request that health information be amended if you have reason to believe it is inaccurate or incomplete.
  6. Request that CBHA communicate with them through alternate means or locations if use of the standard communications process would endanger an enrollee or others.
  7. Privacy and confidentiality regarding your clinical information, including your diagnoses; information shall be kept in strict confidence and shall not be shared with anyone without the enrollee’s written permission, except as permitted or required by law.
  8. Request restrictions on uses and disclosures of protected health information.
  9. Access to services and CBHA providers within timeframes that meet the needs of the current situation, including immediate access in case of emergency.
  10. Be informed about CBHA providers, including location, office hours and specialties.
  11. Participate with practitioners in decision-making regarding treatment planning, including a clear explanation of diagnoses and treatment options, regardless of cost or benefit coverage, and, in cases where medication is prescribed, a clear explanation of the medication(s), including any possible side effects.
  12. Be informed of all facts about any charges and bills received, regardless of who is responsible for payment.
  13. Be provided with information about how to file a complaint, grievance or appeal; to file a complaint or grievance; to appeal any denial of services in accordance with CBHA policies and applicable law.
  14. Receive a copy of your rights and responsibilities and make recommendations on CBHA’s member rights and responsibilities policy.

ENROLLEE RESPONSIBILITIES

Enrollees whose behavioral health benefits are managed by Carolina Behavioral Health Alliance (CBHA), have the responsibility to:

  1. Read and adhere to the guidelines of the health plan as they appear in the Certificate of Coverage, benefit booklet or other benefits materials.
  2. Present your ID card before receiving each service and to pay the appropriate co-payment at the time of the service. Protect your ID card from unauthorized use.
  3. Provide CBHA and its providers accurate and relevant information regarding current and past health condition(s) to ensure appropriate care and treatment; this includes granting a release of information and helping to obtain medical records from former providers of care, if applicable.
  4. Actively participate with providers in the development of treatment plans, to cooperate with agreed upon treatment goals, instructions and guidelines and to discuss progress or lack of progress with your providers.
  5. Inform your providers of care of any changes in your health care benefits.
  6. Report concerns about fraud, abuse or quality of care.
  7. Make and keep appointments for non-emergency behavioral care, to adhere to the treatment plan and to take medications as prescribed. If it is necessary to cancel an appointment, you have a responsibility to give the provider’s office adequate notice.
  8. Inform providers of any changes in medication prescribed by other practitioners.
  9. Notify your group administrator and CBHA if you have any additional coverage; notify the group administrator of any changes regarding dependents and marital status as soon as possible.
  10. Be considerate and courteous to CBHA providers, their staff and CBHA representatives.

If you have any questions, please feel free to call CBHA at 1-800-475-7900 or write to us at: P.O. Box 571137, Winston-Salem, NC 27517-1137.

© 2009 Carolina Behavioral Health Alliance, Inc. All Rights Reserved.
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