YOUR RIGHTS

YOUR RESPONSABILITIES

ADVANCE DIRECTIVES

FRAUD AND ABUSE

CAREGIVER REGISTRY
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YOUR RIGHTS

You have the right to:

  • Be treated with respect and in a dignified way.
  • Get written information from your Insurer in English and Spanish and translated into any other language. You also have the right to get written information in an alternative format. Afterwards, you have the right to get all future written information in that same format or language, unless you tell your Insurer otherwise.
  • Get information about your Insurer, health care facilities, health care professionals, health services covered, and how to access services.
  • Choose a Primary Medical Group, your PCP, and other doctors and providers within your Preferred Provider Network.
  • Choose a dentist and a pharmacy among your Insurer’s network.
  • Contact your doctors when you want to and in private
  • Get medically necessary care that is right for you, when you need it. This includes getting emergency services, 24 hours a day, 7 days a week.
  • Be told in an easy-to-understand way about your care and all of the different kinds of treatment that could work for you, no matter what they cost or even if they aren’t covered.
  • Help to make decisions about your health care. You can turn down care.
  • Ask for a second opinion for a diagnosis or treatment plan.
  • Make an Advanced Directive. Look here for more information.
  • Get care without fear of physical restraint or seclusion used for bullying, discipline, convenience or revenge.
  • Ask for and get information about your medical records as the federal and state laws say. You can see your medical records, get copies of your medical records, and ask to correct your medical records if they are wrong.
  • File a complaint or an appeal about your Insurer or your care. Look here for more information. The complaint can be filed in your Insurer’s office or in the Patience Advocate office.
  • Get services without being treated in a different way because of race, color, birthplace, language, sex, age, religion, or disability. You have a right to file a complaint if you think you have been treated unfairly. If you complain or appeal, you have the right to keep getting care without fear of bad treatment from your Insurer, providers, or Vital Plan.
  • Choose an Authorized Representative to be involved in making decisions.
  • Provide informed consent.
  • Only have to pay the amounts for services listed here. You can’t be charged more than those amounts.
  • Be free from harassment by your Insurer or its Network Providers with respect to contractual disputes between the Insurer and its Providers;

Your Right to Privacy (HIPAA)
Your health information is private. The law says that ASES and your Insurer must protect your information. ASES and your Insurer can share your information for your care, to pay your health claims, and to run the program. But we can’t share your information with others unless you tell us we can. If you want to know more about what information we have, how we can share it, or what to do if you don’t want your health information shared with certain people, call your Insurer.

 

Enrollee Services
1-844-336-3331 (toll free)
787-999-4411 TTY (hearing impaired)
Monday through Friday
from 7:00 a.m. to 7:00 p.m.
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Postal Address
PO BOX 72010
San Juan, PR 00936-7710

Physical Address
Central Offices
Fundación Angel Ramos Anexo, 2do piso Ave. Chardón, Hato Rey, PR

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