Rights and Responsibilities

As a enrollee of CareFirst CHPDC your are entitled to certain rights and responsibilities

At CareFirst CHPDC we always strive to bring you great health care service backed up by friendly and courteous enrollee services.  Below you will find a list of your rights and responsibilities of your health care enrollment with us.

Your Rights and Responsibilities

You have a right to:

• Be treated with respect and dignity.
• Know that when you talk with your doctors and other providers its private. 
• Have an illness or treatment explained to you in a language you can understand.
• Participate in decisions about your care.
• Refuse treatment or care.
• Be able to see your medical records and to request that they be fixed if they are wrong.
• Choose an eligible PCP from within CareFirst CHPDC’s network and to change your PCP.
• Make a Complaint (“Grievance”) about the care provided to you and receive an answer.
• Request an Appeal or a Fair Hearing if you believe CareFirst CHPDC was wrong in denying, reducing or stopping a service or item.
• Obtain medical care without unnecessary delay
• Receive information on advance directives and choose not to have or continue any life-sustaining treatment.
• Receive a copy of CareFirst CHPDC Enrollee Handbook.
• Continue treatment you are currently receiving until you have a new treatment plan.
• Receive interpretation and translation services free of charge if you need them.
• Refuse oral interpretation services.
• Get an explanation of prior authorization procedures.
• Obtain summaries of customer satisfaction surveys.
• Receive CareFirst CHPDC’s “Dispense As Written” policy for prescription drugs.
• Receive family planning services and supplies from the provider of your choice.
• Be free from any form of restraint or seclusion used as coercion, discipline, convenience or retaliation, as specified in other federal regulations on the use of restrains and seclusion.
• Receive information about benefits available under the District plan, but not covered by CareFirst CHPDC.
• To a candid discussion of appropriate or medically necessary treatment options for your conditions regardless of cost and benefit coverage.
• Have direct access to a women’s health specialist within the network for the covered care necessary to provide women’s routine and preventive healthcare services. Also, female enrollees have a right to designate as their PCP a participating provider or an advanced practicing registered nurse who specializes in obstetrics (OB) and gynecology (GYN).
• Ask for a chaperone to be present when you receive health care.
• Receive information about CareFirst CHPDC Health Plan’s financial condition and any special ways we pay our doctors.

You have a right to:

• Received information about CareFirst CHPDC, our services, our providers and other health care workers, our facilities, and your rights and responsibilities as a enrollee.
• Receive a second opinion from a qualified health care provider within the network, or arrange for the enrollee to obtain one outside the network, at no cost to you.
• Be informed about how and where to access any benefits available under the district of Columbia plan but not covered under the contract, including any cost sharing, and how transportation is provided upon enrollment, annually an at least 30 days prior to any change.
• Not be held liable for the CareFirst CHPDC’s debts in the event of the CareFirst CHPDC’s insolvency.
• Use any hospital or other setting for emergency care.
• Be treated no differently by providers or by CareFirst CHPDC for exercising your rights listed here.

You are responsible for:

• Treating those providing your care with respect and dignity.
• Following the rules of the D.C. Medicaid Managed Care Program and CareFirst CHPDC.
• Following plans and instructions you receive from your doctors and other providers.
• Going to Appointments you schedule or that CareFirst CHPDC schedules for you.
• Telling your doctor at least 24 hours before the Appointment if you have to cancel.
• Asking for more explanation if you do not understand your doctor’s instructions.
• To make recommendations regarding CareFirst CHPDC’s Enrollee Rights and Responsibilities policy.
• Going to the Emergency Room only if you have a medical emergency.
• Telling CareFirst CHPDC and your PCP about medical and personal problems that may affect your health, to help them to provide you care.
• Reporting to Economic Security Administration (ESA) and CareFirst CHPDC if you or a family enrollee have other health insurance.
• Trying to understand your health problems and participate in developing treatment goals to help CareFirst CHPDC and PCP provide your care.
• Helping your doctor get medical records from providers who have treated you in the past.
• Telling CareFirst CHPDC if you were injured as the result of an accident or at work.