Your Rights and Responsibilities
As a SFHP Medi-Cal member, you have the right to:
- To be treated respectfully, with dignity, no matter what your gender, culture, language, appearance, sexual orientation, race, disability and transportation ability is, giving due consideration to your right to privacy and the need to maintain confidentiality of your medical information.
- To be provided with information about the plan, our services, including Covered Services, our practitioners and providers and your rights and responsibilities.
- To be provided information about all health services available to you, including a clear explanation of how to get them.
- To be able to choose a primary care provider within the Contractor’s network.
- To participate in decision making regarding your own health care, including the right to refuse treatment.
- To be able to have candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage.
- To voice complaints or grievances, either verbally or in writing, about the organization or the care received.
- To receive care coordination.
- To request an appeal of decisions to deny, defer, or limit services or benefits.
- To receive oral interpretation services for their language.
- To receive free legal help at your local legal aid office or other groups.
- To formulate advance directives.
- To have access to family planning services, Federally Qualified Health Centers, Indian Health Service Facilities, sexually transmitted disease services and Emergency Services outside the Contractor’s network pursuant to the federal law.
- To request a State Hearing, including information on the circumstances under which an expedited hearing is possible.
- To have access to, and where legally appropriate, receive copies of, amend or correct your Medical Record.
- To disenroll upon request. Beneficiaries that can request expedited disenrollment include, but are not limited to, beneficiaries receiving services under the Foster Care, or Adoption Assistance Programs; and members with special health care needs.
- To access Minor Consent Services.
- To receive written member informing materials in alternative formats (including braille, large-size print, and audio format) upon request and in a timely fashion appropriate for the format being requested and in accordance with W & I Code Section 14182 (b)(12).
- To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
- To receive information on available treatment options and alternatives, presented in a manner appropriate to your condition and ability to understand.
- To receive a copy of your medical records, and request that they be amended or corrected, as specified in 45 CFR §164.524 and 164.526.
- Freedom to exercise these rights without adversely affecting how you are treated by the Contractor, providers or the State.
- To make recommendations regarding our member rights and responsibilities policy.
- Right to oral interpretation should be at no cost to the member.
As an SFHP Medi-Cal member, you have the responsibility to:
- Carefully read all SFHP materials immediately after you are enrolled so you understand how to use your SFHP benefits.
- Ask questions when needed.
- Follow the provisions of your SFHP membership as explained in this Handbook.
- Be responsible for your health understand your health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible.
- Follow the treatment plans your provider develops for you and consider and accept the possible consequences if you refuse to follow with the treatment plans or recommendations.
- Ask questions about your medical condition and make certain that you understand the explanations and instructions you are given.
- Make and keep medical appointments and let your provider know ahead of time when you must cancel.
- Communicate openly with your provider so you can develop a strong partnership based on trust and cooperation.
- Offer suggestions to improve SFHP.
- Help SFHP and your providers maintain accurate and current medical records by providing information promptly about changes in address, family status, other health plan coverage, and information needed to provide you with care.
- Notify SFHP as soon as possible if you are billed inappropriately or if you have any complaints.
- Treat all SFHP staff and health professionals respectfully and courteously.
- As required by Medi-Cal Program, pay any premiums, co-payments and charges for non-covered services on time.
- You may refuse, for personal reasons, to accept procedures or treatment recommended by your medical group or primary care provider. If you refuse to follow a recommended treatment or
procedure, your medical group or primary care provider will let you know if he or she believes that there is no acceptable alternative treatment. You may seek a second opinion as provided in this Handbook. If you still refuse the recommended treatment or procedure, then SFHP has no further responsibility to provide any alternative treatment or procedure that you seek.
- Using your ID cards properly. Bring your SFHP ID card, a photo ID, and your Medi-Cal ID card with you when you come in for care.
- Telling us if you receive care at a non-SFHP contracted facility/provider.
- If you require an interpreter, you should request an interpreter in advance prior to your appointment.