Rights and Responsibilities

You have rights and responsibilities as a CareFirst BlueCross BlueShield Community Health Plan Maryland (CareFirst CHPMD) member.

Your Rights

As a CareFirst CHPMD member, you have the right to:

• Get help in your language.
• Be treated with respect, dignity, and privacy.
• Get clear information about all treatment options, even if they are not covered.
• Talk about all treatment options for your health, no matter the cost or coverage.
• Make choices about your care, including saying no to treatment.
  • If you’re under 18 and married, pregnant or have a child, you can help decide your or your child’s care.
• Not be punished, isolated or treated unfairly.
• Talk to your doctor about your medical records. You can ask for a copy or request changes as allowed.
• Use your rights without fear of being treated badly by your doctor or CareFirst CHPMD.
• Choose your Primary Care Provider (PCP), change PCPs and have privacy during visits
• Get information about how CareFirst CHPMD works, including services, policies and procedures, doctors, member rights and any changes.
• Expect your health records and information to be private unless you say it’s okay to share.
• Get a second opinion from another CareFirst CHPMD doctor if you do not agree with your doctor's opinion.
• Make recommendations about our member rights and responsibilities.
• File appeals and grievances with us if you’re unhappy with your care or coverage.
• File appeals and grievances with the State.
• Receive a State fair hearing.
• Ask to keep getting care during an appeal or hearing. You may have to pay if the decision goes against you.
• Know you or your doctor cannot be penalized for filing an appeal or grievance.

Additional information on Appeals and Grievances can be found in your Member Handbook.

Your Responsibilities

As a CareFirst CHPMD member, you are responsible for:

• Taking part in your care and working with your doctor on treatment.
• Learning about your health and helping set your care goals.
• Calling CareFirst CHPMD if you have a problem or concern with your healthcare services and need help.
• Telling your doctor right away if you went to the emergency room.
• Treating doctors, their staff and CareFirst CHPMD employees with respect.
• Telling your doctor about your symptoms and problems and asking questions if you don't understand.
• Following the care plan you and your doctor agree on.
• Talking to your doctor if you’re having trouble following their directions.
• Giving your doctors and CareFirst CHPMD information they need to help you.
• Calling CareFirst CHPMD before seeing a new PCP and letting us know if you want to change your PCP.
• Keeping appointments and being on time. Call if you need to cancel or are running late.

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CareFirst CHPMD complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, gender identity, sexual orientation or pregnancy status. If you believe you have been discriminated against on the basis of race, color, national origin, age, disability, sex, gender identity, sexual orientation or pregnancy status please file a complaint with:

CareFirst BlueCross BlueShield Community Health Plan Maryland
c/o Appeals and Grievance Department
PO Box 915
Owings Mills, MD 21117
Phone: 410-779-9369 or toll-free at 800-730-8530 Fax: 844-329-0831

If you believe that the Maryland Department of Health has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with: Maryland Department of Health, Office of Equal Opportunity Programs, Equal Access Compliance Unit (EACU), 201 West Preston Street, Room 422, Baltimore, Maryland 21201, 410-767-6600 (Voice) 410-333-5337 (Fax), mdh.oeop@maryland.gov (email). Deaf and hard of hearing individuals may use relay.

You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, EACU staff are available to help you.

You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, the Appeals and Grievance Department is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf or by mail or phone at:

U.S. Department of Health and Human Services 200 Independence Avenue, SW
Room 509F, HHH Building Washington, D.C. 20201
800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.