abarca health feels strongly that information about consumer rights and responsibilities empowers beneficiaries, patients receiving our services, and their caregivers. It is the policy of abarca health to proactively communicate consumer’s rights and responsibilities in a clear and consistent manner.
Consumers have the right to be treated with respect and dignity at all times, and to exercise their rights to be treated fairly according to federal and local law.
Consumers may make recommendations regarding the abarca health Consumer Rights and Responsibilities policies, as well as provide input into their satisfaction with services provided by the company.
Consumers have the right to receive information about abarca health PBM services, benefit and fee structure, including limitations and exclusions to the formulary, retail and specialty pharmacy network.
Consumer inquiries about medications, prior-authorization processes and appeals will be acknowledged and respected by abarca health staff and the contracted pharmacy network.
Consumers can participate in the decision-making regarding their medication treatment and receive a clear explanation from our clinical pharmacist about their medications.
Consumers can voice their complaints regarding abarca health, its prior-authorization services, appeals processes, or denials, and you have the right to an investigation or second level of review.
Consumers are entitled to covered benefits and prior-authorization reviews within specified timeframes by certified pharmacists who can effectively communicate medication treatment plans.
Consumer records are kept confidential to the degree protected by federal and state laws including HIPAA regulations.
Consumers with language barriers may receive translation services when contacting abarca health.
Consumers have the responsibility to read their insurance certificate for PBM coverage and contact abarca health if they do not understand the information.
Consumers have the responsibility of reporting unethical practices from our provider network as well as any fraud, waste or abuse practices.
Consumers have the responsibility to follow instructions from their prescribing physician as to the optimal use of prescribed therapies and to adhere to their medications as recommended by the treating physician.
Consumers have the responsibility to ensure that they are not paying cash for drugs that have coverage under their benefit plan.
Consumers have the responsibility to pay any applicable insurance copayments at the time of service.