Your Rights as an AmeriHealth Caritas North Carolina Member

Member Rights and Responsibilities

As a member of AmeriHealth Caritas North Carolina, you have certain rights and responsibilities. AmeriHealth Caritas North Carolina will respect your rights and make sure that no one working for our health plan, or any of our providers, will prevent you from using your rights. Also, we will make sure that you are aware of your responsibilities as a member of our health plan. For a full list of your rights and responsibilities as a member of AmeriHealth Caritas North Carolina visit our website or call Member Services at 1-855-375-8811 (TTY 1-866-209-6421).

Your Rights

As a member of AmeriHealth Caritas North Carolina, you have a right to:

  • Receive information about the organization, its practitioners and providers, their rights and responsibilities, benefits and services, and the cost of health care.
  • Receive information on where, when and how to get the services you need from AmeriHealth Caritas North Carolina.
  • Be treated with respect and recognition of your dignity and your right to privacy, without regard for health status, sex, race, color, religion, national origin, age, marital status, sexual orientation or gender identity.
  • Receive considerate and respectful care in a clean and safe environment. 
  • Request materials and/or assistance in languages and formats other than written English, such as Braille, audio or sign language, if necessary. 
  • Be furnished with health care services consistent with applicable state and Federal law. 
  • Receive health care services in a timely manner from a provider that meets your care needs. 
  • 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 language you understand. 
  • Candid discussion and information with your health care provider about appropriate or medically necessary treatment options and alternatives for your conditions, regardless of cost or benefit coverage, in a manner that you understand.
  • Participate with practitioners in making decisions about your health care. 
  • Get a second opinion about your care.
  • 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.
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.
  • Request and receive a copy of your medical record as allowed by applicable state and Federal law.
  • Ask, if needed, that your medical record be amended or corrected.
  • Be sure that your personal and health information and medical records are private and confidential.
  • Approve or deny the release of identifiable medical or personal information, except when the release is permissible and/or required by law.
  • Request an Accounting of Disclosures of Protected Health Information (PHI).
  • Expect that AmeriHealth Caritas North Carolina will provide the Notice of Privacy Practices upon enrollment, annually, and upon your request
  • Request that any mailing or communication with PHI from AmeriHealth Caritas North Carolina be sent by alternate means or to an alternate address or phone number.
  • Make recommendations regarding the organization’s Member Rights and Responsibilities Policy and other policies and procedures.
  • Use the AmeriHealth Caritas North Carolina grievance process to resolve grievances (complaints) and to file an appeal. You can also contact the Medicaid Managed Care Ombudsman Program any time you feel you were not fairly treated.
  • Use the State Fair Hearing system
  • Provide an advance health care directive.
  • 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.

Help from Member Services

  • Member Services has people to help you. You can call Member Services at 1-855-375-8811 (TTY 1-866-209-6421), 24 hours a day, seven days a week. 
  • In case of a medical emergency, call 911. 
  • You can call Member Services to get help when you have a question. You may call us to get a PCP, to ask about benefits and services, to get help with referrals, to replace a lost Medicaid 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 North Carolina 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, we can help. Just call us and we will find a way to talk with you in your own language. 
  • For people with disabilities: If you have difficulty hearing or need assistance communicating, call us. 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 equipped with special communications devices. Also, we have services like:
    • TTY machine. Our TTY phone number is 1-866-209-6421.
    • Information in large print
    • Help in making or getting to appointments
    • Names and addresses of providers who specialize in your condition
    • If you use a wheelchair, we can tell you if a provider's office is wheelchair accessible and assist you in making or getting to appointments

Special aids and services

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

  • A TTY machine. Our TTY phone number is 1-866-209-6421.
  • 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 at no cost. To ask for services, call Member Services at 1-855-375-8811 (TTY 1-866-209-6421).

If you believe that AmeriHealth Caritas North Carolina failed to provide these services, you can file a complaint. To file a complaint or to learn more, call Member Services at 1-855-375-8811 (TTY 1-866-209-6421).

Members