MEMBERS

     American Behavioral is pleased to administer your behavioral health benefits. We take great pride in the value of service and the quality network of providers available to our consumers. American Behavioral strives to serve you in every way possible.

     The term "consumer" refers to a person whose behavioral healthcare benefits are administered by American Behavioral. Whenever possible, American Behavioral shall deal directly with the consumer, who must be represented adequately in every interaction. The consumer may designate a representative, if necessary.

     Understanding your corporate behavioral healthcare benefits enables you to make the most of them. Through the American Behavioral system, you have the following rights and responsibilities. Please take a moment to read these.

As a consumer, you have the right to:

• Be treated in a manner which affirms your worth, dignity and need for privacy.
• Obtain information in understandable terms pertinent to your diagnosis, treatment and prognosis from a physician or other provider. If it is not advisable to give the information directly to you, the information shall be made available to an appropriate person on your behalf.
• Be given information regarding the professionals providing behavioral health services on your behalf via the network offered by American Behavioral.
• Render or withhold informed consent before the start of any procedure or treatment.
• Refuse any medications, treatment or other procedures offered, to the extent provided by law. And also to be informed by a physician regarding any medical consequences of your refusal of any medications, treatments or procedures.
• Obtain emergency mental health services when medically necessary without needless delay.
• Receive quality services in a prompt and productive manner.
• Have all records and information therein pertaining to behavioral health care regarded as confidential materials unless otherwise specified by law.
• Not have your coverage refused, denied, or canceled solely on the basis of your mental health.
• Have access to information about American Behavioral services, practitioners, clinical guidelines and Consumer Rights and Responsibilities.
• Work with your providers in making decisions about your treatment.
• All information pertaining to appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage.
• Redress of complaints in a prompt, responsive manner.
• File an appeal if a non-certification is rendered.
• Make recommendations regarding American Behavioral Consumer Rights and Responsibilities policies.

As a consumer, you have the responsibility to:

• Provide, to the extent possible, information that American Behavioral and its network of practitioners and providers need in order to care for you.
• Follow the plans and instructions for care that you have agreed upon with your practitioners.
• Participate, to the degree possible, in understanding your behavioral health problems and developing mutually agreed upon treatment goals.

As a consumer, you have the responsibility to understand the following:

• By applying for coverage and participating in this plan, you authorize American Behavioral to obtain, use and release all records about you and your dependents that are needed in order to administer this plan.
• All behavioral healthcare services, except in emergencies, must be obtained and approved through American Behavioral and the associated network of providers.
• All hospitalizations must be approved by American Behavioral and arranged by a participating physician, except in behavioral healthcare emergencies.
• Hospital emergency services shall be used only for true emergency situations in which a person is a threat of harm to self or others.
• Each covered consumer must always carry his/her American Behavioral identification card. The card is to be shown to the provider each time behavioral health services are sought. Identification cards are not for use by unauthorized persons.
• Notify the human resources department of your employer, as well as American Behavioral., regarding any changes in address, eligible family consumers and marital status. Notification is also required regarding any secondary insurance coverage, due to need for coordination of benefits.
• Provide complete and accurate information concerning your behavioral healthcare and associated needs to providers and to American Behavioral in order to ensure medical necessity and prevent duplication of services.
• Co-payments are to be paid directly to the participating provider who renders care.
• You will be responsible to a provider for all appropriate fees if you have an appointment with a provider and fail to give a timely notice (usually 24 hours in advance) before missing the scheduled appointment.

As a consumer, you have the right to file an appeal, complaint or grievance

     If you, for any reason, wish to file an appeal, complaint or grievance, you can do so either by phone or by sending a written document. For telephonic appeals, complaints or grievances call American Behavioral at (205) 871-7814 in the Birmingham, AL, area or toll free at (800) 677-4544 outside the Birmingham area. If you wish to file a written document, please make sure the following information is included:

• The patient's name;
• The patient's contract number;
• Information such as date of service, provider name, procedure (if known) and claim number (if available), so American Behavioral will have enough information to reasonably identify the claim(s) or issue in question; and,
• A statement that you are filling an appeal, complaint or grievance.

     Send written appeals, complaints or grievances to: American Behavioral, 550 Montgomery Highway, Suite 300, Birmingham, AL 35216.

     If you have any other questions regarding your corporate behavioral healthcare benefits administered by American Behavioral, please call your human resources department.