Member Rights and Responsibilities

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Our Commitment to You

Our goal is to provide high-quality medical care and advanced medical treatment. We also promise to listen, treat you with respect, and understand your individual needs. Members have rights and responsibilities. The following is a description of your rights and responsibilities.

Member Rights

You have the right to:

  • Complain to us about Banner – University Family Care/ACC (B – UFC/ACC) and/or care provided.
  • Request information on the structure and operation of B – UFC/ACC or its subcontractors.
  • Information about B – UFC/ACC's services, health care providers, admission, transfer, discharge, billing policies, and members' rights and responsibilities.
  • Be treated fairly regardless of race, ethnicity, national origin, religion, gender, age, behavioral health condition (intellectual) or physical disability, sexual preference, genetic information, or ability to pay.
  • Be told about Physician Incentive Plans that affect referral services.
  • Know that B – UFC/ACC is required to participate in a stop-loss insurance program.
  • Be told the types of plans B – UFC/ACC uses for compensation.
  • Get a summary of member survey results.
  • Receive care that meets your needs in a way that doesn’t judge values, language, and how much a person is able to do. 
  • B – UFC/ACC and their participating providers safeguard the confidentiality of your information as required by state and federal law, including your B – UFC/ACC specific record set and your medical (care) records kept by your provider(s).
  • B – UFC/ACC specific record set: The law states that you have the right to read or get copies of your medical claim history, pharmacy claim history, grievance and appeals documents, and your B – UFC/ ACC phone call records at no cost to you from B – UFC/ACC. To receive those records, B – UFC/ACC must have the request in writing. You may make this request by calling our Customer Care Center. You will be sent an authorization form to complete and will return it to the Compliance Department with a copy of a picture ID so we can make sure we only send your records to you or someone you allow to receive your records. You can receive your records in paper form or by email (encrypted or not) if you prefer. There is some level of risk that a third party could access your Protected Health Information (PHI) without your consent when electronic media or email is unencrypted. We are not responsible for unauthorized access to unencrypted media or email or for any risks (e.g., Virus) potentially introduced to your computer/device when receiving PHI in electronic format or email.
  • Coordination of care with schools and state agencies may occur within the limits of applicable regulations.
    A second opinion from a qualified health care professional within B – UFC/ACC's network. If an in-network second opinion is not available, you have the right to have a second opinion arranged outside of the B – UFC/ACC network at no cost to you.
  • Receive information on available treatment options and alternatives in a manner that is appropriate to your condition and is easy to understand.
    Make Advance Directives and appoint someone to make health care decisions for you. You or your representative can change your Advance Directives at any time. You have the right to be provided with information about formulating Advance Directives. B – UFC/ACC must ensure involvement by you or your representative in decisions to withhold resuscitative services, or to forgo or withdraw life-sustaining treatment within the requirements of Federal and State law with respect to Advance Directives [42 C.F.R. 438.6]). For members in a HCBS or a behavioral health residential setting that have completed an Advance Directive, the document must be kept confidential but be readily available. For example: in a sealed envelope attached to the refrigerator.
  • MEDICAL CARE RECORDS: The law states that you have the right to read, or annually request and receive a copy of your medical care records at no cost to you (from any provider who provides care for you). Contact your provider to ask to see or get a copy of your medical record. You will receive a response to your request within 30 days. However, your right to access medical care records may be denied if the information is psychotherapy notes, compiled for, or in a reasonable anticipation of a civil, criminal or administrative action, protected health information subject to the Federal Clinical Laboratory Improvement Amendments of 1988 or exempt pursuant to 42 CFR 493.3(a)(2), or a licensed health care professional has determined that receiving or accessing your records would likely endanger the life or safety of you or another person. If your access is denied for some of these reasons, you have the right to have the denial reviewed. Providers must allow you to review your records by reading them at the provider's office or giving you a copy or both. If your provider does not give you the records or does not respond to your request within 30 days, please contact B – UFC/ACC Customer Care Center at (800) 582-8686 or TTY 711 for assistance.
  • B – UFC/ACC must reply to your request for medical records no later than thirty (30) days after receipt of your request. If B – UFC/ACC is unable to take any action within thirty (30) days, B – UFC/ACC may take an additional 30 days. B – UFC/ACC will let you know the reason for the delay and the date the request will be completed. This response will either be a copy of your records in the manner you requested, permission for you to view your records on-site, or a reason for denying your request. If a request is denied, in whole or in part, B – UFC/ACC must give you a reason for the denial and your rights to a review of the denial of access.
  • Request to have any provider who provides care for you amend or correct your medical care records that are kept by your treating provider. You may initiate this request by calling our Customer Care Center and your response will be required in writing.
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.
  • Information needed to help you make informed decisions.
  • Receive information on beneficiary and plan information.
  • Help in decision making about your health care and Advance Directives (decisions about what kind of care you would like to receive if you become unable to make medical decisions). This includes the right to refuse treatment.
  • Be treated with respect and with due consideration for your dignity and privacy. We understand your need for privacy and confidentiality including protection of any information that identifies you.
  • Have a list of available PCPs, including those who speak a language other than English and access to a sign language interpreter for the hearing impaired.
  • Have language interpretive services from a provider who speaks your primary language, if other than English.
  • Written materials in alternate formats.
  • Seek Emergency Service at any hospital or other Emergency Room facility (in or out of network).
  • Be treated in a safe, supportive, and smoke-free environment.
  • Choose your primary care provider within the B – UFC/ACC network.
  • You or someone who represents you to take part in resolving problems about your health care decisions.
  • Involve family members or other people you choose to help you make decisions about your treatment plans.
  • Request a copy of the Notice of Privacy Practices at no cost to you. The notice describes B – UFC/ACC's privacy practices and how we use health information about you and when we may share that health information with others.
  • Request the criteria that decisions are based on.
  • Receive health care services if you are an American Indian member from any Indian Health Service provider or tribally owned and/or operated facility at any time.
  • Exercise his or her rights and that the exercise of those rights shall not adversely affect service delivery to the member [42 CFR 438.100(c)].
  • File a complaint and B – UFC/ACC will provide assistance in filing your complaint.
  • Appeal any denial of services you feel B – UFC/ACC should pay for. We will also assist you in filing an appeal.