Member Rights and Responsibilities

As a Vaya Health NC Medicaid Direct member, you have certain rights and responsibilities. Vaya will respect your rights and make sure that no one working for us, or any of our providers, will prevent you from exercising your rights.

Your Rights

As a Vaya NC Medicaid Direct member, you have a right to:

• Be cared for with respect and with consideration for your dignity and privacy without regard for health status, sex, race, color, religion, national origin, age, marital status, sexual orientation, or gender identity.
• Be told what services are available to you.
• Be told where, when, and how to get the services you need from Vaya.
• Be told of your options when getting services so you or your guardian can make an informed choice.
• Be told by your providers what behavioral health issues you may have, what can be done for you and what will likely be the result, in a way you understand. This includes other languages in addition to English.
• Get a second opinion about your care.
• Give your approval of any treatment.
• Give your approval of any plan for your care after that plan has been fully explained to you.
• Refuse care and be told what you may risk if you do.
• Get information about your behavioral health care.
• Get a copy of your behavioral health record and talk about it with your provider.
• Ask, if needed, that your behavioral health record be amended or corrected.
• Be sure that your behavioral health record is private and will not be shared with anyone except as required by law, contract, or with your approval.
• Use the Vaya grievance process to voice complaints about Vaya or the care you receive. You can also contact the NC Medicaid Ombudsman any time you feel you were not fairly treated.
• Request an appeal of an adverse decision by Vaya or one of our subcontractors.
• Use the State Fair Hearing system.
• Appoint someone you trust (relative, friend, or lawyer) to speak for you if you are unable to speak for yourself about your care and treatment.
• Receive considerate and respectful care in a clean and safe environment, free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.
• Receive information about Vaya, available services, Vaya network practitioners and providers, and member rights and responsibilities.
• Participate with your practitioners in making decisions about your health care.
• Have a candid discussion about appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage.
• Make recommendations about Vaya’s Member Rights and Responsibilities Policy.

Your Rights if You Are a Minor

• Minors have the right to agree to some treatments and services without the consent of a parent or guardian:
• Treatment for sexually transmitted diseases.
• Services related to pregnancy.
• Services to help with alcohol and/or other substance use disorders.
• Services to help with emotional conditions.

Your Responsibilities

As a Vaya NC Medicaid Direct member, you agree to:

• Work with your provider to protect and improve your behavioral health.
• Find out how your behavioral health coverage works.
• Listen to your provider’s advice and ask questions.
• Treat health care staff with respect.
• Tell us if you have problems with any health care staff by calling Member and Recipient Services at 1-800-962-9003.
• Keep your appointments. If you must cancel, call as soon as you can.
• Use the emergency department only for emergencies.
• Call Vaya’s Behavioral Health Crisis Line at 1-800-849-6127 if you are having a behavioral health crisis.
• Supply information (to the extent possible) that Vaya and your practitioners and providers need to provide care.
• Follow plans and instructions for care that you have agreed to with your practitioners.
• Understand your health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible.