Protecting Your Privacy

We follow the Health Insurance Portability and Accountability Act (HIPAA) Privacy Regulations to protect your personal health information (PHI). We do not disclose information about you or any former members to anyone, except as  permitted by HIPAA. All AvMed employees sign a confidentiality statement and are trained in the proper handling of personal information. Each time you call Member Services, you will be asked to verify your AvMed member ID number, address, phone number and date of birth. If you’re calling for another AvMed member, you need to identify yourself, relationship to the member you’re calling about, and verify the member’s ID number, address, phone number and date of birth. Member Services can then confirm whether a referral request has been received and if it’s been approved.

To request a written copy of the Notice of Privacy Practices, please contact Member Services at 1-800-882-8633 (1-800-782-8633 for  Medicare members). TTY/TDD users may call 305-671-4948 in the Miami area (in all other areas, call 1-877-4428633). You can also e-mail and we’ll respond  within 24 hours.

For Web site Terms of Use, and privacy concerns, please visit “Your Privacy” on the home page.

Member Rights and Responsibilities

Members Have a Right to:

• Considerate, courteous and dignified treatment by all participating providers without regard to race, religion, gender, national origin or disability, and  a reasonable response to a request for services,  evaluation and/or referral for specialty care.
  
• Receive information about AvMed Health Plans, our products and services, our contracted practitioners and providers, and members’ rights and responsibilities.
  
• Be informed of the health services covered and available to them or excluded from coverage,  including a clear explanation of how to obtain services and applicable charges. 
  
• Access quality care, receive preventative health services and know the identity and professional status of individuals providing services to them.
  
• The confidentiality of information about their medical health condition being maintained by the Plan and the right to approve or refuse the release of member specific information including medical records, by AvMed, except when the release is required by law.
  
• Participate in decisions involving their health care and to give informed consent for any procedure after receiving information about risk, length of inactivity and choices of alternative treatment plans available, regardless of cost or benefit coverage.
  
• To refuse medical treatment, including treatment considered experimental, and to be informed of the medical consequences of this decision.
  
• Have available and reasonable access to service during regular hours and to after-hours and emergency coverage, including how to obtain out-of-area coverage.
  
• A second opinion from another participating physician or non-participating consultant in the AvMed Health Plans’ service area.*
  
• Know about any transfer to another hospital, including information about why the transfer is necessary and any available alternatives.
  
• Be fully informed of the complaint and grievance processes and use them without fear of interruption of health services.
  
• To make recommendations regarding the Plan’s members’ rights and responsibilities policies.
  
• Written notice of any termination or change in  benefits, services or the member's providers.
  

*A portion of the cost of a non-participating consultant will be the responsibility of the member. This benefit includes consultation only and does not guarantee continued care  with the consulting provider.

Members have the responsibility to:

• Choose an AvMed participating Primary Care Physician and establish themselves with this physician.**
  
• Become knowledgeable about their health plan coverage, including covered benefits, limitations  and exclusions, procedures regarding use of  participating providers and referrals.
  
• Take part in improving their health by maximizing healthy habits.
  
• Provide accurate and complete information about their health.
  
• Ask any questions and seek any clarification necessary to adequately understand their illness and/or treatment. Follow the recommended and mutually agreed upon treatment plan.
  
• Keep appointments reliably and promptly notify the  provider when unable to so.
  
• Fulfill financial obligations for receiving care, as required by their health plan agreement, in a timely manner.
• Show consideration and respect to providers and provider staff.

** Certain AvMed Plans do not require that you choose a Primary Care Physician. However, AvMed encourages all members to establish a relationship with a Primary Care Physician to help coordinate your care.