Rights & Responsibilities

You have the right to:

  • Be treated with respect to your dignity and privacy by health care providers, their staff and all individuals employed by CareFirst Community Health Plan Maryland (CareFirst CHPMD).
  • Receive information, including information on treatment options and alternatives regardless of cost or benefit coverage, in a manner you can understand.
  • Take part in decisions about your health care; including the right to refuse treatment. If you are under 18 and married, pregnant or have a child, you can expect that you will be able to participate in and make decisions about your and/or your child’s health care.
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.
  • Talk to your Primary Care Provider about your medical record, request and get a copy of your medical records; or ask that these records be amended or changed as allowed.
  • Have a candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage.
  • Exercise your rights and to know that the use of those rights will not badly affect the way that CareFirst CHPMD or our providers treat you.
  • File appeals and grievances with us about our organization or the care we provide, including requesting an independent review of a decision to deny or limit coverage (see the Member Handbook section on Grievances and Appeals).
  • File appeals and grievances with the State (see the Member Handbook the section on The State’s Complaint Process).
  • Receive a State fair hearing (see the Member Handbook section on The State’s Appeal Process).
  • Request that ongoing benefits be continued during an appeal or State fair hearing however, you may have to pay for the continued benefits if our decision is upheld in the appeal or hearing (see the Member Handbook section on Fair Hearings).
  • Know you or your provider cannot be penalized for filing a grievance or appeal.
  • Get a second opinion from another CareFirst CHPMD provider if you do not agree with your doctor’s opinion about the services that you need. Call us at 410-779-9369 or 1800-730-8530 for help with this. TTY users should call 711.
  • Have information about how CareFirst CHPMD is managed, including our services, policies and procedures, providers, and member rights and responsibilities, and any changes made. Call us at 410-779-9369 or 1-800-730-8530 for help with this. TTY users should call 711.
  • Make recommendations regarding our member rights and responsibilities.
  • Expect that your records and communications will be treated confidentially and not released without your permission.
  • Choose your own Primary Care Provider, choose a new Primary Care Provider and have privacy during a visit with your Primary Care Provider.
  • Get help from someone who speaks your language.

You have the responsibility to:

  • Be involved in your health care and work with your doctors about recommended care.
  • Understand your health problems and participate in developing mutually agreed upon treatment goals.
  • Call CareFirst CHPMD if you have a problem or concern with your health care services and need help.
  • Tell your doctor as soon as possible after you get emergency treatment.
  • Treat your providers, their staff and CareFirst CHPMD employees with respect and dignity.
  • Tell your doctor about your symptoms and problems and ask questions when you do not understand.
  • Follow the instructions and plan of care agreed upon by you and your provider(s).
  • Talk to your providers about any problems you may have in following their directions.
  • Cooperate with your doctors and CareFirst CHPMDto the extent possible, supply the information needed in order to provide care.
  • Call CareFirst CHPMD before seeing a new Primary Care Provider and let us know that you would like to change your Primary Care Provider.
  • Make and keep appointments and be on time. Always call if you need to cancel an appointment or if you will be late.

CareFirst CHPMD provides health coverage to our members on a nondiscriminatory basis, according to state and federal law, regardless of gender, race, age, religion, national origin, physical or mental disability, or type of illness or condition.