Your Rights as an AmeriHealth Caritas Delaware Member
AmeriHealth Caritas Delaware complies with applicable federal civil rights laws and does not discriminate on the basis of race; ethnicity; color; sex; religion; national origin; creed; marital status; age; Vietnam era or disabled veteran status; income level; gender identity; the presence of any sensory, mental, or physical handicap; or any other status protected by federal or state law.
AmeriHealth Caritas Delaware is committed to complying with all applicable requirements under federal and state law and regulations pertaining to member privacy and confidentiality rights.
As a member, you have the right to:
- Get information about:
- AmeriHealth Caritas Delaware and its health care providers.
- Your rights and responsibilities.
- Your benefits and services.
- The cost of health care services and any required cost sharing.
- Have AmeriHealth Caritas Delaware and its health care providers treat you with dignity and respect and recognize your right to privacy.
- Get materials or help in languages and formats other than written English, such as braille, audio, or sign language, as indicated, at no cost to you.
- Receive help with interpretation services, as indicated, at no cost to you.
- Receive materials that are written in a manner and format that are easily understood and culturally sensitive.
- Have personal and health information and medical records kept private and confidential.
- Expect that AmeriHealth Caritas Delaware will give you a copy of its Notice of Privacy Practices without your request, and:
- Approve or deny the release of identifiable medical or personal information, except when the release is required by law.
- Request a list of disclosures of protected health information.
- Request and receive a copy of your medical records as allowed by applicable state and federal law.
- Ask that AmeriHealth Caritas Delaware amend certain protected health information.
- Ask that any AmeriHealth Caritas Delaware communication that contains protected health information be sent to you by alternative means or to an alternative address.
- Receive health care services consistent with applicable state and federal law.
- Talk with your health care provider about:
- Treatment plans.
- Information on available treatment options and alternatives, given in a way you understand.
- The kinds of care you can choose to meet your medical needs, regardless of cost or benefit coverage.
- Be a part of decisions about your health care, including the right to refuse treatment. Your decision to do so will not negatively affect the way AmeriHealth Caritas Delaware, its health care providers or DHSS treats you.
- Make a complaint (grievance) or appeal about AmeriHealth Caritas Delaware or its health care providers about the care provided to you, and for you to receive an answer.
- File a state fair hearing with DHSS if you are not satisfied with the outcome after completing the AmeriHealth Caritas Delaware appeals process.
- Make an advance directive.
- Be given an opportunity to provide suggestions for changes to AmeriHealth Caritas Delaware’s enrollee rights and responsibilities.
- Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.
- Be free from discrimination prohibited by state and federal law.
- Treatment in the least restrictive setting.
- Fully participate in the community and to work, live, and learn to the fullest extent possible.
- Be free to exercise your rights without adverse treatment from AmeriHealth Caritas Delaware, its health care providers, or DHSS.
- Have access to, and receive, quality health care services that are available and accessible to you in a timely manner.
- Furnished health care services that are sufficient in amount, duration, or scope and provided in a culturally competent manner to meet your specific needs.
Notices of Privacy Practices
When it comes to your health information, you have certain rights.
You have the right to:
- Get a copy of your health and claims records.
- You can ask to see or get a copy of your health and claims records and other health information we have about you. Ask us how to do this.
- We will provide a copy or a summary of your health and claims records, usually within 30 days of your request.
- Ask us to correct health and claims records.
- You can ask us to correct your health and claims records if you think they are incorrect or incomplete. Ask us how to do this.
- We may say “no” to your request, but we’ll tell you why in writing within 60 days.
- Request confidential communication.
- You can ask us to contact you in a specific way (for example, by home or office phone) or to send mail to a different address.
- We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not.
- Ask us to limit the information we share.
- You can ask us not to use or share certain health information for treatment, payment, or our operations.
- We are not required to agree to your request, and we may say “no” if it would affect your care.
- Get a list of those with whom we’ve shared your information.
- You can ask for a list (called an “accounting”) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
- We will include all the disclosures except for those about treatment, payment and health care operations, and certain other disclosures (such as any you asked us to make).
- Get a copy of this privacy notice.
- You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you a paper copy promptly.
- Choose someone to act for you.
- If you have given someone medical power of attorney or if someone is your legal guardian, that person can act for you and your rights and make choices about your health information.
- We will make sure the person has this authority and can act for you before we take any action.
- File a complaint if you believe your privacy rights have been violated.
You can complain if you feel we have violated your rights, call AmeriHealth Caritas Delaware Member Services, 24 hours a day, seven days a week, at:
- Diamond State Health Plan: 1-844-211-0966 (TTY 1-855-349-6281).
- Diamond State Health Plan-Plus: 1-855-777-6617 (TTY 1-855-362-5769
You can file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, online or by sending a letter to 200 Independence Avenue, S.W., Washington, DC 20201, or by calling 1‑877-696-6775.
We will not retaliate against you for filing a complaint.