Pioneering a New Approach to Behavioral Health—Together

Members/Clients have the right to:

1. Receive information about New Directions, its services, its Network Providers and Affiliates, and their rights and responsibilities;
2. Be treated with respect and receive recognition of their dignity and right to privacy;
3. Participate with Network Providers and Affiliates in decisions about their health care;
4. Receive a candid discussion of appropriate or medically necessary treatment options for their health conditions, regardless of cost or benefit coverage;
5. Voice complaints or appeals about New Directions or the care it provides, either verbally or in writing, and obtain prompt resolution; and
6. Make recommendations regarding this "Statement of Rights and Responsibilities for Members and Clients."

Members/Clients accept the responsibility to:

1. Provide information (to the extent possible) that New Directions and its Providers and Affiliates need to provide health care;
2. Follow the plans and instructions for care and treatment plans agreed upon with their Providers and Affiliates; and
3. Understand their health conditions and participate in developing mutually agreed upon treatment goals, to the extent possible.

1. If you wish to give access to your information to someone else (spouse, family member, your child's guardian, your employer, parent, etc.), you can complete the Authorized Delegate Form, which allows New Directions to share information about your healthcare account with whomever you designate.
2. Authorized Delegate Instruction Form
3. Authorized Delegate Form
4. Spanish Authorized Delegate Form

Description of Appeals Process

You may have the right to request an independent external review of your case if you’ve been denied coverage of a health care service because it has determined that the service is not medically necessary or is experimental or investigational.

You may first need to exhaust your internal appeal options unless you and your plan agree to waive the internal appeal process.

To file an External Appeal, please submit the applicable forms below. These forms can be faxed or mailed to:

816-237-2382 FAX

NDBH
ATTN: External Appeals
P.O. Box 6729
Leawood, KS 66206

• Appointment of Authorized Representative Form
• Certificate for Experimental or Investigational Treatment Form
• Certificate of Treating Health Care Provider For Expedited External Review Form
• External Review Request Form
• What to Send and Where to Send (External Appeals)
• Authorization for Release of Protected Health Information
• Authorized Delegate Form
• Spanish Authorized Delegate Form