Member Information

We serve members from many cultures and backgrounds.

 Please contact us at 1-800-656-8991, TTY 711, 8 a.m. – 8 p.m., 7 days a week for help.

Or, you may e-mail us at HCHComments@azblue.com.

Non Discrimination Notice and Notice of Availability

Member Language Services flyer
English | Spanish | Navajo | Vietnamese

You have the right to: Be treated with fairness and respect; Keep your medical records and Personal Health Information (PHI) private; Access plan providers, receive covered services, and fill prescriptions within a reasonable time; Learn about your treatment options and participate in care decisions; Use Advance Directives like a Living Will or Power of Attorney; Make complaints; Obtain information about our plan, providers, benefits and costs, and your prescription drug coverage. 

Learn More About Your Rights

If you have questions about your rights and protections, please call us or get free help and information from:

DES Aging and Adult Administration
State Health Insurance and Assistance Program
1789 W. Jefferson, St., 950A
Phoenix, AZ 85007

The Medicare program has written a booklet called Your Medicare Rights and Protections. To get a free copy, call 1-800-MEDICARE (1-800-633-4227). You can visit Medicare.gov to request this booklet or download a copy.

If you believe you have faced unfair treatment or your rights have been ignored, your actions should depend on your situation. If you think you have been treated unfairly due to your race, color, national origin, disability, age, or religion, please let us know. Or, you can call the Office for Civil Rights in your area at:

Phoenix Office
275 W. Washington St.,
Phoenix, AZ 85007
Toll free: 1-877-491-5742
Toll free TDD: 1-877-624-8090

Tucson Office
400 W. Congress, Ste, S215,
Tucson, AZ 85701
Toll free: 1-877-491-5740
TDD toll free: 1-877-881-7552

For any other kind of concern or problem related to your Medicare rights and protections described in this section, you can call us. You can also get help from Arizona’s SHIP.

Your Responsibilities as a Member 

As a member of our plan, you also have responsibilities.

Your responsibilities include the following:

• Learn about your benefits and the rules for getting care.
• Share information your doctors need. Follow your treatment plan. Ask questions when something is not clear.
• To act in a way that supports the care given to other patients and helps the smooth running of your doctor’s office, hospitals, and other offices.
• Pay any copays you owe. Pay other costs that are your responsibility.
• Contact us if you have questions or concerns.
• Tell us if your address, phone number, or contact information changes.

Fraud, waste, and abuse (FWA) can increase health care costs and affect member services.

Types of FWA

Claims:

• Double billing
• Billing for services not provided
• Submission of false documents
• Billing non-covered services as covered

Member:

• Identity theft
• Doctor shopping
• Prescription stockpiling
• Misrepresentation of eligibility or medical condition

For potential Fraud-Waste-Abuse complaints, you may call our Compliance Alert Line

All Medicare Advantage plan organizations, like Health Choice Pathway, must obey federal laws against retaliation. If you report fraud, waste, and abuse to us, it will not affect the medical care you receive.

If you witness any instances of Medicare fraud, waste, or abuse, please call the Compliance Alert Line, toll-free at 1-800-237-0916 (TTY 711), 24 hours a day, 7 days a week. You can call this number any time and leave a confidential message.

Please leave a detailed message with the following information:

• Your name – please state whether you are a member, provider, or employee of our plan
• Telephone number
• Include all information that supports the referral

You may remain anonymous. Your call will receive the same attention whether you identify yourself or not.

Make a Fraud, Waste and Abuse Referral

Health Choice Pathway
8220 N. 23rd Avenue
Phoenix, AZ 85021

Please make a copy and keep for your records before mailing or faxing it to us. If you have questions about appointing someone to speak or make healthcare decisions on your behalf, please call us.

Appointment of Representative Form
Appointment of Representative Form (Spanish)

We will share only the health information you approve. Use this form if you want us to share your health information with another person.

If you decide that you want to appoint someone who we can disclose personal health information on your behalf, please fill out the form below and mail or fax your form to:

Health Choice Pathway
8220 N. 23rd Avenue
Phoenix, AZ 85021
Fax: 480-760-4635

Please make sure you make a copy and keep for your records before mailing or faxing it to us.

If you have questions about appointing someone to speak or make healthcare decisions on your behalf, please call us.

Authorization to Disclose PHI Form
Authorization to Disclose PHI Form (Spanish)

As one of our valued members, we have you covered if the Governor, the U.S. Secretary of Health and Human Services, or the President of the United States declares a state of disaster or state of emergency in our service area.

If you are affected by a declared state of disaster or state of emergency, we will:

• During an emergency, you may get covered care from out-of-network providers. Your costs will stay the same. Providers must be Medicare certified. 
• Waive applicable medical prior authorization requirements in full.
• Allow members to fill their prescriptions at a non-network pharmacy. We will waive the one-time fill restriction should the state of disaster or state of emergency exceed thirty days. You will pay the normal out-of-network differential cost in addition to your designated copay or coinsurance.
• Permit members to refill prescription medications even if it is too soon for a refill. We will also override prior authorization, step therapy, and quantity limit restrictions for up to 90 days or until the declared state of disaster or state of emergency ends.

Your expanded access to non-network providers and facilities will end when one of the following conditions are met:

• If thirty days have elapsed since the declaration of the public health emergency or state of disaster, and no end date was identified by the original source or the Centers for Medicare and Medicaid Services (CMS), it will be considered the end of the disaster.
• The source that declared the public health emergency or state of disaster declares an end.
• CMS declares an end of the public health emergency or state of disaster.

There may come a time when you are too sick or injured to make your own health care decisions. Federal and Arizona law protect your right to plan ahead and let others know your wishes.

An Advance Directive is a legal document that explains the health care you want or do not want if you cannot speak for yourself. It can also name someone you trust to make health care decisions for you.

Types of Advance Directives

Arizona recognizes four main types of Advance Directives:

1. Living Will
2. Health Care Power of Attorney
3. Mental Health Care Power of Attorney
4. Prehospital Medical Care Directive (Do Not Resuscitate)

Living Will

A Living Will tells your doctors what kind of medical care you want if you become seriously ill and cannot make decisions for yourself.

For example, it can explain whether you want:

• A breathing machine (ventilator)
• Tube feeding or other artificial nutrition and hydration
• Other treatments that may prolong your life

Health Care Power of Attorney

A Health Care Power of Attorney lets you choose another adult to make health care decisions for you if you cannot make them yourself. This person is called your agent. Choose someone you trust who understands your wishes and is willing to speak on your behalf.

Mental Health Care Power of Attorney

A Mental Health Care Power of Attorney allows you to name someone to make decisions about your mental health treatment if you are unable to make those decisions yourself.

Prehospital Medical Care Directive (DNR)

A Prehospital Medical Care Directive tells emergency medical personnel that you do not want certain lifesaving treatments if your heart stops beating or you stop breathing. You can get a free copy of this form by calling the Bureau of Emergency Medical Services at 602-364-3150.

Making Your Advance Directive Legal

To make an Advance Directive valid in Arizona, you must:

• Understand what you are signing
• Sign and date the document
• Have your signature either:
• Witnessed by a qualified adult witness, or
• Notarized by a Notary Public.

The witness cannot be:

• Your health care provider
• The person you name as your agent
• A person involved in paying for your health care
• A person who may inherit your property, unless they are related to you by blood, marriage, or adoption

If you cannot sign your name, another person may sign for you if you direct them to do so and they sign in your presence.

After You Complete Your Advance Directive

Once your forms are completed:

• Keep the original documents in a safe place.
• Give copies to your doctor, hospital, health care agent, and family members or others who may be involved in your care.
• Talk to your loved ones about your wishes.
• Review your forms from time to time and update them if your wishes change.
• If you create a new Advance Directive, provide copies to everyone who received the previous version.

If you have questions about your right to make health care decisions, please call us at 1-800-656-8991.

To read more on Arizona state laws on Advance Directives, visit Life Care Planning | Arizona Attorney General (azag.gov)

You may also contact:

Arizona Division of Aging and Adult Services
1789 W. Jefferson, Site Code 950A
Phoenix, AZ 85007
Phone: (602) 542-4446

Your local Area Agency on Aging or senior center may also have forms and information to help you complete an Advance Directive.

Health Care Directive