Member Rights and Responsibilities
AmeriHealth Caritas Florida and its network of primary care providers (PCPs) and other providers of services do not discriminate against members based on race, national origin, sex, religion, disability, age, sexual orientation, or any other basis prohibited by law.
AmeriHealth Caritas Florida 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:
- Getting information about:
- AmeriHealth Caritas Florida and its health care providers.
- Your rights and responsibilities.
- Your benefits and services.
- The cost of health care services and any required cost sharing.
- 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.
- Emergency services do not require prior approval.
- You can use any hospital for emergency care.
- We give you lists of emergency conditions.
- You will learn what to do after you have received emergency care.
Keeping yourself and your family healthy can be easy. Here is the list of what you need to do.
- Read your member handbook. Call Member Services if you have questions.
- Choose your new PCP when you get your welcome kit. Help your new PCP care for you and your family. Fill out all information sheets carefully. Help your PCP get your records from your previous doctor. Give, as much as possible, information that AmeriHealth Caritas Florida needs to process claims, and information providers need to give care.
- Help your providers manage your care. Understand your health problems and take part in developing treatment goals. Follow plans and instructions for care from your providers. If your care plan does not work, tell your provider. He or she wants you to feel better. He or she will adjust your care plan to make it work.
- Keep your appointments for all regular care. Examples are child health check ups (CHCUPs), family planning, and health screenings.
- Get a referral from your PCP before you see a specialist or out-of-network provider or go to the hospital. Only go to the hospitals or specialists your PCP recommends. If you visit an out-of-network provider, you will need prior authorization by calling 1-855-371-8074.
- If your member ID card is ever lost or stolen, call Member Services.
- Present your member ID card any time you receive medical services from a doctor, hospital, clinic, or pharmacy.
- Call your PCP when you feel sick. Do not wait. Go to the nearest ER if you feel your life is in danger.
- Call Member Services if any information about you or your family changes, including your mailing and home address. This helps us avoid most problems. If your address has changed, please log in to your My ACCESS account and update your address. You can also contact the ACCESS Customer Call Center toll free at 1-866-762-2237. You must also contact the Social Security Administration (SSA) toll free at 1-800-772-1213 or visit the SSA website
- Be kind to everyone involved in your care. Be on time for your appointments. Call the doctor’s office if you cannot keep your appointment.
Patient responsibility for facility-based services
Patient responsibility is the cost of Medicaid facility-based services not paid for by the Medicaid program and is the amount a member must contribute toward the cost of their care. This amount is determined by the Department of Children and Families and is based on income and type of placement. Members are required to pay this patient responsibility as determined by the Department of Children and Families.
To file a complaint or to request more information, call the following toll-free numbers:
AmeriHealth Caritas Florida member service line
1-855-355-9800, 24 hours a day, 7 days a week
AHCA statewide consumer telephone line
1-888-419-3456, 8 a.m. - 6 p.m.