Rights | Responsibilities | Concerns & Complaints | Cultural Competency
Other Insurance | Advance Directives | Moving Away | Fraud & Abuse | Your Privacy

Our Commitment to You
University Family Care’s goal is to provide high-quality medical care and advanced medical treatment. We also promise to listen, treat you with respect, and understand your individual needs. Members have rights and responsibilities. The following is a description of your rights and responsibilities.

Member Rights

1. You will receive care that meets your needs in a way that doesn’t judge race, religious beliefs, values, language, how much a person is able to do, age, handicap, or ability to pay.

2. You will be treated with respect and dignity. We understand your need for privacy and confidentiality.

3. You will be treated in a safe, supportive and smoke-free environment.

4. You have the right to information about University Family Care’s services, health care providers, admission, transfer, discharge, billing policies, and members’ rights and responsibilities.

5. You have the right to choose your primary care physician within the limits of the University Family Care network.

6. The law states that you have the right to read or get copies of your medical records. You also have the right to help in decision making about your health care and Advance Directives (including Living Wills and Powers of Attorney).

7. You have the right to complain about University Family Care and care provided.

8. Your wishes are important. You have the right to the information needed to help you make informed decisions. Here is a list of some but not all of your rights.

a. You can accept or refuse any treatment. You will be informed of any consequences of refusing treatment.

b. You can make Advance Directives and appoint someone to make healthcare decisions for you. You or this person can change your Advance Directives at any time.

c. You or someone who represents you can take part in resolving problems about your care decisions.

9. You have the right to the following:

• You can be told about Physician Incentive Plans that affect referral services.
• You can be told the types of plans University Family Care uses for compensation.
• You can learn whether stop-loss insurance is needed.
• You can get a summary of member survey results.

10. You have the right to know of providers who speak a language other than English.

11. You have the right to have a list of available PCPs.

Member Responsibilities

1. It is your responsibility to provide, to the best of your knowledge, information to help our University Family Care staff care for you.

2. It is your responsibility to follow instructions and guidelines given by those providing health care.

3. It is your responsibility to know the name of your assigned primary care physician (PCP).

4. It is your and your family members’ responsibility to be considerate of the rights and property of patients and staff. This includes smoking and visitation policies.

5. It is your responsibility to pay your co-payments for care received as soon as possible.

6. It is your responsibility to schedule appointments during medical office hours whenever possible before using urgent care.

7. It is your responsibility to arrive on time and to let the medical office know in advance when you can’t keep an appointment.

8. It is your responsibility to bring immunization records to every appointment for children 18 years old or younger.

9. University Family Care provides care in Maricopa County only. If you are planning on moving out of the county, it is very important that you do the following:

• Call your eligibility office with your new address.
• Call AHCCCS Enrollment at 1-800-334-5283 so that you can be enrolled in an AHCCCS plan in your new area.
• Call your new health plan to choose a PCP.
• Call the University Family Care Member Services Department at 1-888-708-2930 and notify them of this change.

10. If you are moving out of state, call your eligibility office as soon as possible. KidsCare members with out of county/out of state moves must call the AHCCCS KidsCare Unit toll free at 1-877-764-5437.

11. If your address or phone number changes, it is very important that you report it.

• Call your eligibility office with your new address.
• Call Member Services at 690-6811 (or 1-888-708-2930 if you’re outside the Tucson area) with your new address.
• KidsCare members can call 1-877-764-5437 toll free.

Concerns & Complaints

Q. What if l have questions, problems or complaints about University Family Care?
A. If you have a specific grievance or dissatisfaction with any aspect of your care, your Member Representative will help you. (This does not include an appeal of an “action” by UFC) Oral interpretation services are available in any language at no cost to you. You may request information in a prevalent non-English language.

You may file your grievance (dissatisfaction) in writing to Member Services. Your complaint will be reviewed and a response will be provided within 45 days. Examples of grievances are: service issues, transportation issues, quality of care issues, provider office issues. A grievance does not include any “action” or denial by UFC.

Q. What if l disagree with a denied service?
A. If you are dissatisfied with an “action” or denial of services by UFC you may file an “appeal.” An appeal must be filed in writing within 60 days from UFC’s Notice of Action letter.

Q. Who may file an appeal?
A. You as the enrollee, or your representative, or a legal representative of a deceased enrollee’s estate, may file an appeal. A provider, acting on behalf of an enrollee and with the enrollee’s written consent, may file an appeal.

Q. What can I file an appeal for?
A. The reasons you may file an appeal are:

• denial or limited authorization of a requested service, including the type of level of service
• reduction, suspension or termination of a previously authorized service
• denial, in whole or in part, of payment for a service
• failure to provide services in a timely manner
• failure to act within the timeframe required for standard and expedited resolution of appeals and standard disposition of grievances
• the denial of a rural enrollee’s request to obtain services outside the Contractor’s network under 42CFR 438.52 (b)(2)(ii), when the contractor is the only contractor in the rural area.

Q. How do I file an appeal?
A.You may write to the UFC Appeals Manager at 2701 E. Elvira Road, Tucson, AZ 85706 or you may call 520-690-6811 option 2, or 1-888-708-2930 option 2 (if outside the Tucson area) and ask to speak to the Appeals Manager. You may also call the Appeals Manager directly at 520-690-2700 option 2. University Family Care will provide you with a written decision within 30 days of the appeal filing.

Q. How do I request a Fair Hearing with AHCCCS?
A. If you are not satisfied with the appeal decision, you may file a Request for Hearing with AHCCCS. UFC will send your appeal file to AHCCCS and a hearing date will be scheduled for you to attend. You may contact AHCCCS at 1-602-417-4232 or write to:

AHCCCS Administration
PO Box 25520
Mail Drop 6200
Tucson, AZ 85002-5520.

Q. What is an Expedited Appeal and Hearing?
A. An expedited appeal may be filed on your behalf by your provider if it is determined by UFC that the time to process a standard appeal would seriously jeopardize your health, life or ability to attain, maintain or regain maximum function. An expedited appeal will be resolved within 3 business days. AHCCCS may process a hearing as expedited if the above criteria are met and a decision provided within 3 business days.

Q. If I am currently receiving the services requested, can I continue to receive them during the appeal process?
A. Yes, but the request must be in writing and be received by UFC within 10 days of the receipt of the notice of action letter. However, you may be responsible for payment of those services if UFC upholds the denial.

Cultural Competency

We value the many kinds of people who live in Maricopa County. We understand that there are many different lifestyles and ethnic backgrounds of people in our community. UFC wants to help members have a good health care experience. A difference in values can be a problem. If you feel they are a problem, please contact us. We will help you find a provider who will better understand your personal needs.

UFC provides interpretive services for members at no cost to you. If you cannot speak to your provider because of a language problem, please contact Member Services at 690-6811 (or 1-888-708-2930 if you’re outside the Tucson area).They will help arrange an interpreter for your appointment. They can also provide our printed materials in another language.

Call us and let us know if we have overlooked anything that is important to you. We will try to help. We want you to be comfortable with the people and services that make up University Family Care.

Other Insurance

Sometimes members with other types of insurance such as Medicare, Champus or other commercial plans, are approved for AHCCCS. If you are a member of another insurance in addition to University Family Care, please take a moment to call Member Services and let us know. Our number is 520-690-6811 option 2 or 1-888-708-2930 option 2 (if you are outside the Tucson area). You may also click the link below, fill out the "Coordination of Benefits" form, and send the completed form to us at the following address:

Member Services
University Family Care
2701 E. Elvira Road
Tucson, AZ 85706

When we know about your other insurance, it helps us coordinate with the other plan of care you receive. We call this Coordination of Benefits. If you have another insurance in addition to University Family Care, if often means that you have additional benefits that may not be coveredunder AHCCCS.

When you call us or mail us the comleted form, we will make sure that we have the other insurance listed in our system. You may also call the AHCCCS eligibility office at 1-800-962-6690 to let them know. AHCCCS will then pass the information on to us. Remember, this also includes insurance coverage by divorce or if your child has insurance that is paid for by your former spouse.

Click here for the Coordination of Benefits letter (English and Español)

Special information for our members who have Medicare coverage:
If you have Medicare coverage and you see a doctor that is not on our plan, the charges may not be covered. If you choose to do that without our approval, University Family Care may not pay for those services because they were done by a doctor that is not on our plan. It is important that you work with your PCP to be referred to the right doctors. (This does not include emergency services.)
So why should you call Member Services and let us know?
Because it will help you get the maximum benefits from both coverages!
PLEASE NOTE: If you are on a Medicare HMO and have University Family Care (UFC), you MUST choose a PCP that is contracted with both plans in order for medical services to be covered.

Advance Directives

As a member of University Family Care you have the right to make decisions about your health care. Once your PCP tells you how he/she plans to treat you and the risk of each treatment, you have the right to refuse that treatment.

There may be situations when you can’t make a decision because of a medical condition, such as a coma, or you cannot explain what you want. But, with an Advance Directive, you can still tell your doctor what kind of treatment you want. Advance Directives include Living Wills and Power of Attorney.

Power of Attorney:

A legal document that says you authorize another person to make a decision on your behalf if you cannot make it yourself.

Living Will:

A legal document that states your desires about the type of care you would like to receive if you cannot speak for yourself.

Your PCP can give you the names and telephone numbers of agencies
that can help you create a Living Will or a Power of Attorney.

Moving Away –Out of the County / Out of the State

University Family Care provides care in Maricopa County only. If you plan to move out of the county, it is very important that you do the following:

• Call your eligibility office with your new address.
• Call AHCCCS Enrollment at 1-800-334-5283 so that you can be enrolled in an AHCCCS plan in your new area.
• Call your new health plan to choose a PCP.
• Call the University Family Care Member Services Department at 690-6811 (or 1-888-708-2930 if you’re outside the Tucson area) and notify them of this change.

If you are moving out of state, call your eligibility office as soon as possible. KidsCare member with out of county/out of state moves much call the AHCCCS KidsCare Unit toll free at 1(877) 764-5437.

Fraud and Abuse

Definitions:

Abuse by a provider: Actions that are not wise business or medical practices and result in:

• unnecessary costs to the program
• payment for services that are not medically necessary
• not meeting professional standards for health care

Abuse by a member: Unnecessary costs to the program because of:

• providing false materials or documents
• leaving out important information

Fraud: Any lie told on purpose that results or information that would result in you or some other person receiving unnecessary benefits. This includes any act of fraud defined by Federal or State law.

Examples of Member Fraud and Abuse include but are not limited to:

• Lending or selling your AHCCCS identification card to anyone.
• Changing prescriptions written by any University Family Care provider.
• Giving incorrect information on your AHCCCS application.

Examples of Provider Fraud and Abuse include but are not limited to:

• Use of the Medicaid system by someone who is inappropriate, unqualified, unlicensed or has lost their license.
• Providing unnecessary medical services.
• Not meeting professional standards for health care.

How to Report Fraud and Abuse:
If you suspect a provider or a University Family Care member of fraud and abuse,
please call 690-6811 (or 1-888-708-2930 if you’re outside the Tucson area) to report it.

Penalties:
A person who is suspected of fraud or abuse of the AHCCCS system will be reported to AHCCCS. Penalties for people involved in fraud or abuse may be both civil and criminal.

Your Privacy