Rights & responsibilities

As an Aetna Better Health of Ohio member, you have rights and responsibilities in your health care. If the member is a child, the child’s rights are represented by the child’s parents or legal guardian. If you need help understanding your rights and responsibilities, please call Member Services at 1-855-364-0974 (TTY: 711), 24 hours a day, seven days a week. The call is free.

Your rights

As a member of our health plan you have the following rights:

To receive all services that our plan must provide.
To be treated with respect and with regard for your dignity and privacy.
To be sure that your medical record information will be kept private.
To be given information about your health. This information may also be available to someone who you have legally approved to have the information or who you have said should be reached in an emergency when it is not in the best interest of your health to give it to you.
To be able to take part in decisions about your healthcare unless it is not in your best interest.
To get information on any medical care treatment, given in a way that you can follow.
To be sure others cannot hear or see you when you are getting medical care.
To be free from any form of restraint or seclusion used as a means of force, discipline, ease, or revenge as specified in Federal regulations.
To ask, and get, a copy of your medical records, and to be able to ask that the record be changed/corrected if needed.
To be able to say yes or no to having any information about you given out unless we have to by law.
To be able to say no to treatment or therapy. If you say no, the doctor or our plan must talk to you about what could happen and must put a note in your medical record about it.
To be able to file an appeal, a grievance (complaint) or state hearing.
To be able to get all our written member information from our plan:
- At no cost to you
- In the prevalent non-English language of members on our service area
- In other ways, to help with the special needs of member who may have trouble reading the information for any reason
To be able to get help free of charge from our plan and its providers if you do not speak English or need help in understanding information.
To be able to get help with sign language if you are hearing impaired.
To be told if the health care provider is a student and to be able to refuse his/her care
To be told of any experimental care and to be able to refuse to be part of the care
To make advance directives (a living will).
To file any complaint about not following your advance directive with the Ohio Department of Health.
To change your primary care provider (PCP) to another network PCP at least monthly. We must send you something in writing that says who the new PCP is by the date of the change.
To be free to carry out your rights and know that Aetna Better Health of Ohio, our providers or the Ohio Department of Medicaid will not hold this against you.
To know that we must follow all federal and state laws, and other laws about privacy that apply.
To choose the provider that gives you care whenever possible and appropriate.
If you are a female, to be able to go to a woman’s health provider in our network for covered woman’s health services.
To be able to get a second opinion from a qualified provider in our network. If a qualified provider is not able to see you, we must set up a visit with a provider not in our network.
To get information about Aetna Better Health of Ohio from us.
To make recommendations regarding Aetna Better Health of Ohio’s member rights and responsibilities policy.
To contact the United States Department of Health and Human Services Office of Civil Rights and/or the Ohio Department of Job and Family Services’ Bureau of Civil Rights at the addresses below with any complaint of discrimination based on race, color, religion, sex, sexual orientation, age, disability, national origin, veteran's status, ancestry, health status or need for health services.

Office for Civil Rights
United States Department of Health and Human Services
233 N. Michigan Ave. – Suite 240
Chicago, Illinois 60601
312-886-2359 312-353-5693 TTY

Bureau of Civil Rights
Ohio Department of Job and Family Services
30 E. Broad St., 30th Floor
Columbus, Ohio 43215
614-644-2703 1-866-227-6353 1-866-221-6700 TTY
Fax: 614-752-6381

Laws require that we keep your medical records and personal health information private. We make sure that your health information is protected. For more information about how we protect your personal health information, see Notice of Privacy Policy.

Your responsibilities

Use your ID card when you go to health care appointments or get services. Do not let anyone else use your card.
Know the name of your PCP and your care manager.
Know about your health care and the rules for getting care.
Tell us and your county caseworker when you make changes to your address, telephone number, family size, and other information.
Be respectful to the health care providers who are giving you care.
Schedule your appointments, be on time, and call if you are going to be late to or miss your appointment.
Give your health care providers all the information they need.
Tell us about your concerns, questions or problems.
Ask for more information if you do not understand your care or health condition.
Follow your health care provider’s advice.
Ask questions and talk to your provider about your health if you can.
Tell us about any other insurance you have.
Tell us if you are applying for or get any other health care benefits.
Bring shots record to all appointments for members under 21 years old.
Give your doctor a copy of your advance directive.

Disenrollment rights

We are glad to have you as an Aetna Better Health of Ohio member. We want you to be happy with us. If you have any issues please call us so we can try to resolve them. There are certain times when your membership with Aetna Better Health of Ohio may end.

Medicaid-only members
Because you chose or were assigned to receive only have your Medicaid benefits through Aetna Better Health of Ohio, you can only end your membership at certain times during the year. You can choose to end your membership during the first three (3) months of your initial membership or during the annual open enrollment month. The Ohio Department of Medicaid will send you something in the mail to let you know when it is your annual open enrollment month. If you live in a MyCare Ohio mandatory enrollment area, you must choose another MyCare Ohio plan to receive your health care.

If you want to end your membership during the first three months of your membership or open enrollment month you can call the Medicaid Hotline at 1-800-324-8680 (TTY:711). You can also submit a request on-line to the Medicaid Hotline website at http://www.ohiomh.com/ Most of the time, if you call before the last 10 days of the month, your membership will end the first day of the next month. If you call after this time, your membership will not end until the first day of the following month. If you chose another managed care plan, your new plan will send you information in the mail before your membership start date.

For more information, see your Medicaid-only Member Handbook.

Medicare-Medicaid members
Members who are enrolled with Aetna Better Health of Ohio for both their Medicare and Medicaid benefits can change health plans every month. You can choose to get your Medicare benefits from Medicare Fee-for-Service (FFS) and a Medicare Part D plan, a Program of All-inclusive Care (PACE) plan, or a Medicare Advantage Part D plan. You will have to stay enrolled with Aetna Better Health of Ohio for your Medicaid benefits until your next annual open enrollment, except during your first 3 months of enrollment in a MyCare Ohio plan. If you request a change, you will be effective in your new plan on the first calendar day of the month after your request. To change health plans, call the Medicaid Hotline at 1-800-324-8680 (TTY:711). You can also submit a request on-line to the Medicaid Hotline website at http://www.ohiomh.com/

For more information, see your Medicare-Medicaid Member Handbook.