Member Rights and Responsibilities

Community Behavioral Health (CBH) and its network of providers do not discriminate against members based on race, sex, religion, national origin, disability, age, sexual orientation, gender identity, or any other basis prohibited by law.

As a CBH member, you have the following rights and responsibilities.

Member Rights

As members of CBH, you have certain rights. They are listed below and we invite you to call us if you need help understanding this information.

Receive Information

Each Member has the right to receive information about CBH, our policies, procedures, services, practitioners, providers, and your rights and responsibilities.

Dignity and Privacy

Each Member is guaranteed the right to be treated with respect and consideration for their dignity, right to privacy, and right to confidentiality.

Receive Information on Available Treatment Options

Each Member is guaranteed the right to receive information on available treatment options that are medically necessary presented in a manner appropriate to the Member’s condition and ability to understand, regardless of cost or benefit coverage.

Participate in Decisions

Each Member is guaranteed the right to participate in decisions regarding his or her behavioral health care. You can be a part of your treatment team by asking questions and getting answers before and during your treatment and involving family members and other important people in your treatment.

Refuse Treatment

Each Member (as part of making decisions regarding their care) can refuse treatment. You have the right, under these circumstances, to get an explanation of what may happen if you do not get treatment.

Voice Complaints or Grievances

Each Member has the right to voice complaints about CBH or their care from a provider. Each Member has the right to file a grievance if they are unhappy about any decision made by CBH. See Complaints and Grievances section.

Make Recommendations

Each Member has the right to make recommendations regarding CBH’s Members Rights and Responsibilities Policy.

Free from Restraint or Seclusion

Each Member is guaranteed the right to be free of any restraint or seclusion used as a means of force, discipline, convenience, or retaliation.

Copy of Medical Records

Each Member is guaranteed the right to request and receive a copy of his or her medical records maintained at CBH, and to request they be amended or corrected. See Notice of Privacy Practices for more information.

Free Exercise of Rights

Each Member is free to exercise his or her rights, and the exercise of those rights does not adversely affect the way the Member is treated by CBH and the provider.

Second Opinion

All CBH Members have a right to request a second opinion. Members can request a second opinion from a qualified behavioral health care professional within CBH’s network. CBH Member Services will provide options for a second opinion from an appropriate behavioral health care professional.

Confidentiality

We know that your privacy is important to you. It is very important to us too. CBH wants you to know that we respect your privacy and work to protect it. CBH staff obeys all laws about confidentiality.

Member Responsibilities

CBH and CBH providers expect to be treated fairly, with the same dignity and respect you would want for yourself.

As a CBH Member, your responsibilities are to:

• Provide as much information as you can about why you are seeking help and answer questions as honestly and completely as you are able.
• Understand your health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible.
• Follow through with the plan of care that you and your provider have agreed upon.
• Keep your County Assistance Office, provider, and CBH aware of any changes to your information (address/ phone number). This is very important and will help us provide the best care for you.
• Tell your provider when you don’t understand the treatment plan.
• Tell your provider or therapist if you do not agree with recommendations.
• Report fraud if/when you are aware of it. See below for reporting instructions.

Consent to Mental Health Care

Children under 14 years of age must have their parent’s or legal guardian’s permission to get mental health care. Children 14 years or older do not need their parent’s, or legal guardian’s, permission to get mental health care. All children can get help for alcohol or drug problems without their parent’s or legal guardian’s permission. They can consent to mental health care and have the right to decide who can see their records if they consented to mental health care. In addition, a parent or legal guardian can consent to mental health care for a child who is 14 years old or older, but under 18 years of age.

The chart below explains who can consent to treatment.

Then They 

It is important for everyone that supports a child to work together and be part of the planning for the child’s care. Everyone that supports a child should, whenever possible, share information necessary for the child’s care. To learn more about who can consent to treatment, you can contact CBH Member Services. Sometimes it is hard to understand that a child has privacy rights and can consent to mental health care. CBH can help you better understand these rights so that you can provide the best support for your child that you can.

Billing Information

Providers in CBH’s Network may not bill you for services that CBH covers. Even if your provider has not received payment or the full amount of his or her charge from CBH, the provider may not bill you. This is called balance billing.

When Can a Provider Bill Me?

Providers may bill you if:

• You received services from an out-of-network provider without approval from CBH and the provider told you before you received the service that the service would not be covered, and you agreed to pay for the service;
• You received services that are not covered by CBH and the provider told you before you received the service that the service would not be covered, and you agreed to pay for the service;
• You received a service from a provider that is not enrolled in the Medical Assistance Program.

What Do I Do If I Get a Bill?

If you get a bill from a CBH Network Provider and you think the provider should not have billed you, you can contact CBH Member Services.

If you get a bill from a provider for one of the above reasons that a provider is allowed to bill you, you should pay the bill or call the provider.

Third-Party Liability

You may have Medicare or other health insurance. Medicare and your other health insurance is your primary insurance. This other insurance is known as Third Party Liability (TPL). Having other insurance does not affect your Medical Assistance eligibility. In most cases, your Medicare or other insurance will pay your service provider before CBH pays. CBH can only be billed for the amount that your Medicare or other health insurance does not pay.

You must tell both your CAO and CBH Member Services if you have Medicare or other health insurance. When you go to a provider or to a pharmacy it is helpful to show the provider or pharmacy your Medicare card and your ACCESS card. This helps make sure your health care bills are paid.

Coordination of Benefits

If you have Medicare, and the service or other care you need is covered by Medicare, you can get care from any Medicare provider you pick. The provider does not have to be in CBH’s Network. You also do not have to get prior authorization from CBH. CBH will work with Medicare to decide if it needs to pay the provider after Medicare pays first, if the provider is enrolled in the Medical Assistance Program.

If you need a service that is not covered by Medicare but is covered by CBH, you must get the service from a CBH network provider. All CBH rules, such as prior authorization and specialist referrals, apply to these services.

If you do not have Medicare but you have other health insurance and you need a service or other care that is covered by your other insurance, you must get the service from a provider that is in both the network of your other insurance and CBH’s network. You need to follow the rules of your other insurance and CBH, such as prior authorization and specialist referrals. CBH will work with your other insurance to decide if it needs to pay for the services after your other insurance pays the provider first.

If you need a service that is not covered by your other insurance, you must get the services from a CBH network provider. All CBH rules, such as prior authorization and specialist referrals, apply to these services.

Reporting Fraud and Abuse

How Do You Report Member Fraud or Abuse?

If you think that someone is using your or another member’s ACCESS card to get services, equipment, or medicines, is forging or changing their prescriptions, or is getting services they do not need, you can call the CBH Fraud and Abuse Hotline to give CBH this information. You may also report this information to the Department of Human Services Fraud and Abuse Reporting Hotline.

How Do You Report Provider Fraud or Abuse?

Provider fraud is when a provider bills for services, equipment, or medicines you did not get or bills for a different service than the service you received. Billing for the same service more than once or changing the date of the service are also examples of provider fraud. To report provider fraud you can call the CBH Fraud and Abuse Hotline. You may also report this information to the Department of Human Services Fraud and Abuse Reporting Hotline.