Rights & Responsibilities

Member Rights

As a member of CareSource you have the following rights:

  • To get information about CareSource, its services, providers, and member rights and duties.
  • To get all services that CareSource must provide
  • To be treated with respect and with regard for your dignity and privacy.
  • To be sure your personal information and medical records are kept private.
  • To be given information about your health. This may also be available to someone legally authorized. It may be given to someone you said should be reached in an emergency.
  • To discuss information on any appropriate or medically necessary treatment options and alternatives for your condition, regardless of cost or benefit coverage, in a manner appropriate to your condition and ability to understand.
  • To work with providers  for your health care decisions, including the right to refuse treatment.
  • To get information about any medical care in a way you can understand.
  • To be sure that others cannot hear or see you while you are getting medical care.
  • Be free from any form of restraint or seclusion as a means of coercion, discipline, convenience or retaliation, as specified in federal regulations on the use of restraints and seclusion.
  • To ask for and get a copy of your medical records. And to be able to ask that the record be changed/corrected if needed in accordance with federal privacy law.
  • The right to ask at any time, information on our physician incentive plan, marketing materials or information about the structure and operation of CareSource.
  • To be able to say yes or no to having any of your information given out unless CareSource has to by law.
  • To be able to say no to treatment or therapy. If you or your parent/guardian say no, the doctor or CareSource must talk to you about what could happen. A note must be placed in your medical record about refusing care.
  • To freely be able to file an appeal, a grievance (complaint), or ask for a state fair hearing and that the exercise of these rights will not adversely affect the way  you are
  • To be able to get all written member information from CareSource:
    • At no cost to you
    • In the prevalent non-English languages of members in CareSource’s service area
    • In other formats, to help with special needs
  • To get free help from CareSource and its providers if you do not speak English or need help understanding information.
  • To be able to get help with sign language if you are hearing impaired.
  • To be told if the provider is a student and to be able to refuse his/her care.
  • To get information on treatment options in a way you or your parent/guardian can understand.
  • To make Advance Directives (a written record of your wishes for medical care).
  • To be free to carry out your rights and know that CareSource, our providers, or the Georgia Department of Community Health will not hold this against you.
  • To know that CareSource must follow all federal and state laws, and other laws about privacy that apply.
  • To choose the provider that gives you care whenever possible and appropriate. 
  • Female members have the right to see a women’s health provider for covered women’s health care.
  • To be able to get a second opinion from a qualified network If someone is not available, CareSource must set up a visit with a provider not  on its panel.
  • To go out of network for care if CareSource cannot give a covered service in network.
  • To get information about CareSource from us.
  • To make suggestions about CareSource’s member rights and responsibility policy.
  • To only be responsible for cost sharing in accordance with federal and state regulations and contracts.
  • To not be held liable for CareSource’s debts in the event of insolvency.
  • To not be held liable for covered services provided to you for which DCH or CareSource does not pay the provider that gives the services.
  • To not be held liable for payments of covered services furnished under a contract, referral, or other arrangement to the extent that those payments are more than what you would owe if CareSource provided the services directly.

Member Responsibilities

  • Use only approved providers
  • Keep doctor and dentist visits, be on time, and call 24 hours before to cancel.
  • Follow the advice and care you have agreed to with your ID card.
  • Always carry your ID. Show it when getting care.
  • Never let others use your ID card.
  • Tell your county caseworker and CareSource of a change in phone number or address.
  • Contact your PCP after going to an Urgent Care or after medical or behavioral health care.
  • Let CareSource and the county caseworker know if you are covered by other health insurance.
  • Give information that CareSource and your health care providers need, to the extent possible, to give care.
  • Tell us of suspected fraud as described in the Fraud, Waste and Abuse section.
  • Understand as much as possible about your health issues and take part in reaching goals agreed to with your health care provider.

Member Services: 1-855-202-0729 (TTY: 1-800-255-0056 or 711), Monday – Friday 7 a.m. – 7 p.m.