Rights and responsibilities

Both our members and care providers have rights and responsibilities. Our Member Services representatives serve as their advocates.

Member rights

 

Anthem members have the right to:

 

Privacy:

  • Be treated with respect and with due consideration for their dignity and privacy
  • Expect that we will treat their records, including medical and personal information and communications, confidentially
  • Request and receive a copy of their medical records at no cost for the member and request that the records be amended or corrected
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation as specified in federal regulations

 

 

Take part in decisions regarding their healthcare:

  • Receive information on available treatment options and alternatives presented in a manner appropriate to the member’s condition and ability to understand
  • Engage in candid discussions of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage
  • Receive the full range of services available to you, ensuring that your care is comprehensive without any limitations based on your medical condition
  • Opt out of healthcare (to the extent of the law) and understand the consequences
  • Decide ahead of time the care they want if they become sick, injured, or seriously ill by making a living will
  • Be able to make decisions about their children's healthcare if members are younger than age 18 and married, pregnant, or have children

 

 

Grievances, appeals, and fair hearings:

  • Pursue resolution of grievances and appeals about the health plan or care provided
  • Freely exercise filing a grievance or an appeal without adversely affecting the way they are treated
  • Continue to receive benefits pending the outcome of an appeal or a fair hearing under certain circumstances, where allowed by law

 

 

Anthem information:

  • Receive the necessary information to be an Anthem member in a manner and format they can understand easily
  • Receive a current member handbook and provider directory
  • Receive a copy of the member handbook and/or provider directory by calling Member Services
  • Receive assistance from Anthem in understanding the requirements and benefits of the plan
  • Receive notice of any significant changes in the benefit package at least 30 days before the intended effective date of the change
  • Make recommendations about our rights and responsibilities policies
  • Know how we pay our care providers

 

 

Medical care:

  • Choose their PCPs from our network of care providers
  • Choose any Anthem network specialist after getting a referral from their PCPs, if appropriate
  • Be referred to care providers for ongoing treatment of chronic disabilities
  • Have access to their PCPs or backups 24 hours a day, 365 days a year for urgent or emergency care
  • Get care right away from any hospital when their symptoms meet the definition of an emergency medical condition
  • Get post-stabilization services following an emergency medical condition in certain circumstances
  • Be free from discrimination and receive covered services without regard to race, color, creed, gender, religion, age, national origin, ancestry, marital status, sexual preference, health status, income status, program membership, or physical or behavioral disability, except where medically indicated

Member responsibilities

 

Members have the responsibility to:

 

Respect their healthcare providers:

  • Treat their doctors, their doctors' staff, and employees of Anthem with respect and dignity
  • Not be disruptive in the physician's office
  • Make and keep appointments and be on time
  • Call if they need to cancel an appointment, change the appointment time, or call if they will be late
  • Respect the rights and property of all care providers

 

 

Cooperate with the people providing healthcare:

  • Tell their care providers about their symptoms and problems and ask questions
  • Supply information that care providers need to provide care
  • Understand the specific health problems and participate in developing mutually agreed-upon treatment goals as much as they are able
  • Discuss problems they may have with following their care providers' directions
  • Follow plans and instructions for the care they have agreed to with their practitioners
  • Consider the outcome of opting out of treatment recommended by a care provider
  • Discuss grievances, concerns, and opinions in an appropriate and courteous way
  • Help their care providers obtain medical records from their previous care providers and help their care providers complete new medical records as necessary
  • Secure referrals from their PCPs when specifically required before going to another care provider, unless they have a medical emergency
  • Know the correct way to take medications
  • Go to the emergency room when they have an emergency
  • Notify their PCPs as soon as possible after they receive emergency services
  • Tell their physician who they want to receive their health information

 

 

Follow Anthem policies outlined in the member handbook:

  • Provide proper identification during enrollment
  • Carry their Anthem ID cards with them at all times and report any lost or stolen cards
  • Contact the Indiana Department of Human Services if information on their ID cards is wrong or if there are changes to their name, address, or marital status
  • Call us and change their PCP before seeing the new PCP
  • Tell us about any doctors they are currently seeing
  • Notify Anthem if a member or family member who is enrolled in Anthem has died
  • Report suspected fraud and abuse

 

Code of Federal Regulations – Confidentiality of Substance Use Disorder Patient Records 

Provider roles and responsibilities:

 

Care providers have additional rights and responsibilities, including the right to:

  • Obtain information about the organization's services, staff qualifications, and any contractual relations
  • Decline to participate in or work with the organization’s programs and services on behalf of their patients
  • Be informed about how the organization coordinates interventions with care plans for individual members
  • Know how to contact the case manager responsible for managing and communicating with their patients
  • Be supported by the organization when interacting with members to make decisions about their healthcare
  • Receive courteous and respectful treatment from the organization’s staff
  • Communicate complaints to the organization

The provider manual also contains a copy of these rights and responsibilities. Clinical practice guidelines are available to our providers on our secure provider website (login is required).

 

Provider manual 

Interested in becoming a provider in the Anthem network?

We look forward to working with you to provide quality service to our members.

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Page last updated 10/17/2025