Your Health Matters
Summer 2018, IN THIS EDITION:
- Timely Access to Care is Available for you
- Choose a PCP for Your Adult Care
- Our Quality Improvement (QI) Program
- Your Rights and Responsibilities
- Know Your Pharmacy Benefits
- Do You Need Help Talking to Your Doctor?
- Our Staff Are Not Paid on the Decisions They Make About Your Health Care
- Need Help Managing Your Asthma or Diabetes?
- Tools to Manage Your Health
As an SFHP member, you have the right to a doctor visit within a set time.
The law requires appointments to be available within the following periods:
- Sometimes waiting longer is not a problem. A longer wait time is fine as long as it would not be harmful to your health.
- Your provider may recommend a specific schedule for preventive care and follow-up appointments that do not need these timelines.
Telephone Wait Times
- You can call your PCP or clinic to find out where and how soon you need to get care 24 hours a day, 7 days a week. Your wait time to speak to a provider should not be longer than 30 minutes. If you cannot reach your PCP or clinic, you can call Teladoc© at 1(800) 835-2362 or visit sfhp.org/teladoc.
- Your wait time should not be longer than 10 minutes when calling SFHP and your provider office during normal business hours.
- You can ask for an interpreter at any time. This service must be available at the time of your appointment.
- Tell your provider if you experience long wait times.
- Call SFHP Customer Service at 1(415) 547-7800 or send a message on the member portal at sfhp.org.
Choose a PCP for Your Adult Care
Turning 18 brings more opportunities and more responsibilities. It can mean changing your school, your job, where you live, and how you handle your money. It also means taking a more active role in your health. When you turn 18, it’s time to choose a new primary care provider (PCP) who takes care of adults. You may be able to stay with your PCP if he or she is a family physician. But if you have been going to a pediatric clinic, you will need to switch to a PCP who works with adults. Talk to your PCP about your choices for transitioning to adult care. For more help in finding a PCP for adult care please call SFHP Customer Service at 1(415) 547-7800 (local) or 1(800) 288-5555 (toll-free), or for the hearing impaired, call 1(415) 547-7830 or 1(888) 883-7347 (TDD), Monday – Friday, from 8:30am to 5:30pm. Linguistic services are available, free of charge, for members requiring language assistance.
Our Quality Improvement (QI) Program
Each year, we put together a QI plan for activities with our provider network, including your medical group and hospital, to improve your and all of our members’ health care. This QI plan and outcomes for meeting the QI plan goals are approved by the State Medi-Cal program, too. It is available to all Medi-Cal, Healthy Kids HMO and Healthy Workers HMO members. If you are interested in the details for the QI plan or outcomes, you can find information on our website at sfhp.org/providers/qi-program-evaluations-results/ or request a paper copy by calling us at 1(415) 547-7800 or 1(800) 288-5555 (toll-free).
Your Rights and Responsibilities
Medi-Cal, Healthy Kids HMO, and Healthy Workers HMO members have rights and responsibilities. We tell members their rights and responsibilities through SFHP materials like the SFHP Evidence of Coverage and Member Handbook. These materials list your responsibilities and rights. We also post them online at sfhp.org/wellness. Contact our Customer Service at 1(415) 547-7800 or 1(800) 288-5555 (toll-free) for any questions or requests regarding member rights and responsibilities.
Know Your Pharmacy Benefits
If you need medicines, your doctor will prescribe them to you.
At your visit, let your doctor know which network pharmacy you want to pick up your medicines. To get your medicines show your SFHP Member ID Card to the pharmacy staff. Medi-Cal members do not pay money for medicines covered under their pharmacy benefit. At sfhp.org, you can find more information about your pharmacy benefit. You can view the most up-to-date San Francisco Health Plan formulary and see if your medication is in it. You can see if your medication needs prior authorization, step therapy, or if it is given by a specialty pharmacy. You can find answers to common questions and search for a pharmacy. Click on the Summary of Benefits in your Evidence of Coverage, to review your pharmacy benefit. If you cannot use the internet or have any questions about which medicines are covered, please call Customer Service at 1(415) 547-7800 or 1(800) 288-5555 (toll-free).
Do You Need Help Talking to Your Doctor?
Our Care Management programs can assist you on your journey to better health. We work with our members both in person and over the phone to assess their needs and create a personal care plan. If you feel you or a family member would benefit from this service, please call us at 1(415) 615-4515. This service is FREE for Medi-Cal, Healthy Kids HMO and Healthy Workers HMO members. In our programs, you can:
- Learn how to manage your medical conditions.
- Get referrals for community agencies; including food and behavioral health.
- Work with our team to get ready for your next appointment.
- Work with your care team to better understand your medications.
Our Staff Are Not Paid on the Decisions They Make About Your Health Care
SFHP does not compensate or give incentives based on coverage review decisions by our Utilization Management (UM) staff, nurses, physicians, our medical groups, or our independent medical consultants. We do not reward or provide financial incentives to anyone performing utilization review services for issuing denials of coverage. We do not give financial incentives to encourage utilization review decisions that result in underutilization. We make UM decisions based only on appropriateness of care and service and existence of coverage. If you have any questions regarding utilization review, please call Customer Service at 1(415) 547-7800 or 1(800) 288-5555 (toll-free), or for the hearing impaired, call 1(415) 547-7830 or 1(888) 883-7347 (TDD), Monday – Friday, from 8:30am to 5:30pm. Linguistic services are available, free of charge, to Medi-Cal, Healthy Kids HMO and Healthy Workers HMO members requiring language assistance. After business hours, UM staff can receive secure voicemail, fax, and email. UM staff will respond to messages the next business day. If the message is received after midnight Monday through Friday, the staff will respond the same business day.
Need Help Managing Your Asthma or Diabetes?
We offer two, no-cost disease management programs for Medi-Cal, Healthy Kids HMO and Healthy Workers HMO members:
- SFHP Asthma Care Program
- SFHP Diabetes Care Program
These programs help you if you have asthma or diabetes. If you qualify, you are automatically enrolled in these programs. You may stop at any time. For more information, please call us at 1(415) 547-7800 or 1(800) 288-5555 (toll-free).
Tools to Manage Your Health
We now have a member portal called SFHP HealthLink for all of our Medi-Cal members. In the portal are tools to help you manage your health. These tools
can help with:
- Healthy weight (BMI) maintenance
- Smoking and tobacco use cessation
- Encouraging physical activity
- Healthy eating
- Managing stress
- Avoiding at-risk drinking
- Identifying depressive symptoms
Sign up for SFHP HealthLink today, at sfhp.org and start managing your health with these online tools. For a printed copy of these tools, call our Customer Service at 1(415) 547-7800 or 1(800) 288-5555 (toll-free).
Make an Appointment
Our Service Center can help you fill out and submit your Medi‑Cal application. Call Customer Service at 1(415) 777‑9992 to get started. The Human Services Agency determines who qualifies for the Medi‑Cal Program.
Changes have been made to the San Francisco Health Plan Medi‑Cal, Healthy Workers HMO and Healthy Kids HMO pharmacy formularies.
To view our most recent updates, please go to sfhp.org. If you cannot access the internet or have any questions about which medicines are covered, please call Customer Service at
1(415) 547‑7800 or 1(800) 288‑5555 (toll-free).