Member Rights And Responsibilities

As a Vaya Total Care (Tailored Plan) member, you have certain rights and responsibilities. Vaya will respect your rights and make sure that no one working for our health plan, or any of our providers, will prevent you from exercising your rights.

Your Rights

As a Vaya Total Care member, you have a right to:

• Be cared for with respect and with consideration for your dignity and privacy without regard for health status, sex, race, color, religion, national origin, age, marital status, sexual orientation, or gender identity
• Be told what services are available to you.
• Be told where, when, and how to get the services you need from Vaya.
• Be told of your options when getting services so you or your guardian can make an informed choice.
• Be told by your primary care provider (PCP) what health issues you may have, what can be done for you, and what will likely be the result, in a way you understand. This includes additional languages.
• Get a second opinion about your care.
• Give your approval of any treatment.
• Give your approval of any plan for your care after that plan has been fully explained to you.
• Refuse care and be told what you may risk if you do.
• Get information about your health care.
• Get a copy of your medical record and talk about it with your primary care provider (PCP).
• Ask, if needed, that your medical record be amended or corrected.
• Be sure that your medical record is private and will not be shared with anyone except as required by law, contract, or with your approval.
• Use the Vaya grievance process to settle complaints. You can also contact the NC Medicaid Ombudsman any time you feel you were not fairly treated.
• Use the State Fair Hearing system.
• Appoint someone you trust (relative, friend, or lawyer) to speak for you if you are unable to speak for yourself about your care and treatment.
• Receive considerate and respectful care in a clean and safe environment, free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.

Your Rights if You Are a Minor

Minors have the right to agree to some treatments and services without the consent of a parent or guardian:

• Treatment for sexually transmitted diseases
• Services related to pregnancy
• Services to help with alcohol and/or other substance use disorders
• Services to help with emotional conditions

Your Responsibilities

As a Vaya Total Care member, you agree to:

• Work with your PCP to protect and improve your health.
• Find out how your health plan coverage works.
• Listen to your PCP’s advice and ask questions.
• Call or go back to your PCP if you do not get better, or ask for a second opinion.
• Treat health care staff with respect.
• Tell us if you have problems with any health care staff by calling the Member and Recipient Service Line at 1-800-962-9003.
• Keep your appointments. If you must cancel, call as soon as you can.
• Use the emergency department only for emergencies.
• Call your PCP when you need medical care, even if it is after hours.