Member Rights & Responsibilities

As a member of Vaya Health’s Health Plan, you have certain rights and responsibilities regarding your care.

You have the following rights:

  • The right to confidentiality and privacy
  • The right to be treated with respect and dignity
  • The right to humane care and freedom from mental and physical abuse, neglect and exploitation
  • The right to live as normally as possible while receiving care and treatment
  • The right to be free from unwarranted searches of your person or seizure of your possessions
  • The right to be free from unnecessary or excessive medication, which shall not be used for punishment, discipline or staff convenience and which shall be administered in accordance with accepted medical standards and only upon the order of a physician or other medical practitioner as documented in your health record
  • The right to be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation
  • The right to be free from any form of discrimination prohibited by federal and state laws, rules and regulations
  • The right to freedom of speech and freedom of religious expression
  • The right to exercise the same civil rights as any other citizen, including the right to vote, marry, divorce, make a will and buy, sell and own property, unless the exercise of such rights has been precluded by an unrevoked adjudication of incompetency (adults only)
  • The right to be free from the threat of unwarranted suspension or expulsion from treatment
  • The right to consent to or refuse treatment, except in a medical emergency or an involuntary commitment
  • The right to receive treatment in the most natural, age-appropriate and least restrictive environment possible
  • The right to participate with your treating providers in making healthcare decisions
  • The right to participate in the development and periodic review of your written person-centered treatment or habilitation plan that builds on individual needs, strengths and preferences
  • The right to have an individualized treatment or habilitation plan implemented within 30 days of admission to any inpatient or residential facility
  • The right to ask questions of Vaya Health or your treating providers at any point in the process, and the right to receive accurate information
  • The right to participate in a candid discussion with your treatment providers about medically necessary treatment options and alternatives for the relevant diagnosis or condition, regardless of benefit coverage limitation
  • The right to be informed in advance of the benefits or risks of treatment choices, and the right to a second opinion at no cost to you
  • The right to decide among relevant treatment options and express preferences about future treatment decisions regardless of benefit coverage limitation

 

You have the following responsibilities:

In addition to your rights as a member of Vaya Health’s Health Plan, you can ensure the best outcomes by assuming the following responsibilities:

  • To supply all information (to the extent possible) that Vaya Health and its providers need in order to provide you with the best care possible
  • To invite people who will be helpful and supportive to your treatment team meetings
  • To cooperate with treatment providers and participate in developing mutually agreed-upon treatment goals, to your best degree possible
  • To work on the goals of your mutually developed person-centered plan or Individual Support Plan
  • To follow the plans and instructions for care agreed to with your treatment providers
  • To tell your treating provider, including a doctor, nurse or therapist, about any changes in your health or condition
  • To understand your own health condition(s) or diagnosis, to your best degree possible
  • To ask questions when you do not understand your diagnosis, treatment expectations or care you are receiving
  • To keep and be on time for scheduled appointments
  • If unable to keep an appointment, to cancel it at least 24 hours in advance
  • To meet financial obligations according to any established agreement with your provider
  • To inform your provider (and Vaya Health staff if meeting in person) of any medical condition that is contagious
  • To take your medications as they are prescribed
  • To tell your prescriber or another doctor if you are experiencing unpleasant side effects from medications or if medications do not seem to be helping
  • To tell your treating provider if you do not agree with their recommendations or want to end treatment
  • To use the hospital emergency department only for emergency care
  • To contact the Vaya Health toll-free Access to Services Line if you are in crisis and cannot reach your provider or need access to services
  • To request a discharge plan when leaving a program or facility, to understand the discharge plan, and to commit to following it
  • To respect the rights and property of other individuals and of Vaya Health and provider staff, including other consumers’ privacy rights
  • To be considerate of other consumers, family members and Vaya Health and provider staff
  • To seek out additional support services in the community
  • To read written notices from Vaya Health (or ask them to be read to you), especially notices about changes in benefits, services, or providers
  • To notify the county Department of Social Services (for Medicaid enrollees), provider or Vaya Health toll-free Customer Services Line (for state-funded consumers) right away with any change in your contact information, including your address or telephone number
  • To carry your Medicaid or other insurance card with you at all times and not allow other persons to use or borrow them
  • To review any explanation of benefits carefully to ensure that services billed are accurate
  • To ask for a copy of documents you are asked to sign, and keep these documents somewhere safe
  • Not to share medical records or other sensitive information with anyone except Vaya Health or other insurance program, or a doctor, agency, clinic, hospital or other healthcare provider
  • Not to ask a doctor or other healthcare provider for treatment or care that you do not need
  • To refuse gifts or kickbacks offered by your provider and report the offer to Vaya Health
  • To call the toll-free Fraud and Abuse Hotline if you have any concerns or suspicions about a provider’s billing practices or other compliance issue
  • To tell Vaya Health about any problems you experience with services, contract providers or Vaya Health staff

Call 1-800-849-6127 toll free 24/7 to obtain services and support for mental health, developmental disabilities and substance abuse. Members can request materials in Spanish or English.

Llamar al número gratuito 1-800-849-6127 24/7 para obtener servicios y apoyo a la salud mental, discapacidades de desarrollo y abuso de sustancias. Los miembros pueden solicitar materiales en español o Inglés.