Member Rights and Responsibilities

ApexHealth is committed to treating all enrollees of our plan in a manner that respects their rights. ApexHealth has outlined the rights and responsibilities as a member of our plan.

As a member of ApexHealth, you have the right to:

  1. Be treated with respect and recognition of your dignity and privacy, and not be discriminated against based on race, ethnicity, national origin, disability, religion, gender, or age
  2. Receive basic information about the plan, orally as well as in writing, upon request, about the organization of ApexHealth
  3. Access information in a format that best suits your needs (in languages other than English, in Braille, in large print, or other alternative formats, etc.)
  4. Receive timely access to network providers and prescription drugs, including emergency care services, 24 hours a day, seven days a week
  5. Protect the privacy of your personal health information
  6. Get information about the plan, its network of providers, your covered services and prescription drugs, and your cost-sharing
  7. Know all your treatment options and participate fully in discussions and decisions about your health care
  8. Refuse any treatment recommended to you by any provider
  9. File a complaint, ask for a coverage decision, or ask us to reconsider decisions we have made
  10. Get help if you believe you are being treated unfairly or your rights have not been respected

As a Medicare member of our plan, you have the responsibility to:

  1. Learn about your rights and responsibilities as an ApexHealth member
  2. Tell your doctor and other health care providers that you are enrolled in our plan
  3. Get familiar with your covered services and the rules you must follow to get these covered services
  4. Supply information to ApexHealth and your health care provider(s) that is needed to provide care and coordinate your coverage
  5. Tell us if you have any other insurance coverage or prescription drug coverage in addition to our plan6. Maintain up-to-date contact information with ApexHealth, such as address and phone number
  6. Contribute towards your own health status by being engaged in your health care and following through on provider instructions for care

Member Rights and Responsibilities Upon Disenrollment

If your membership ends with ApexHealth, we want to make sure you understand your rights and responsibilities. Disenrollment from ApexHealth can be voluntary or involuntary.

ApexHealth is responsible for:

  • Processing all eligible voluntary disenrollment and cancellation requests
  • Ending your membership when notified by CMS or the government
  • If ApexHealth ends your membership, we will provide you with a list of reasons in writing explaining why you have been involuntarily disenrolled

You are responsible for:

  • Pay any outstanding balances you may owe us

You have the right to file a complaint if you believe we have violated your rights

You can file a complaint with us or with Medicare. Visit the Coverage Determination, Organization Determination, Appeal and Grievance Procedures page of our website for more information on how to file a complaint with us or with Medicare.

Still have questions?

Please call Concierge Services at 844-279-0508. TTY users should call 711. We are open from 8 a.m. to 8 p.m., (local time), seven days a week from October 1 through March 31 with the exception of Thanksgiving and Christmas, and 8 a.m. to 8 p.m., (local time), Monday through Friday from April 1 through September 30. A voice mailbox will be available on federal holidays and weekends between April 1 through September 30.