Your Rights and Responsibilities

Your Rights and Responsibilities

As a SFHP Medi-Cal member, you have the right to:

  • Be treated respectfully, and 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.
  • Receive information about SFHP, our services, our practitioners and providers and your member rights and responsibilities.
  • Receive information about all health services available to you, including a clear explanation of how to get them.
  • Select a primary care provider to provide or arrange for all the care you need.
  • Receive good and appropriate medical care including preventive health services and health education.
  • Take part actively in decisions about your medical care. To the extent permitted by law, you also have the right to refuse or discontinue treatment.
  • Know and understand your medical condition, treatment plan, expected outcome, and the effects these have on your daily living.
  • Have candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage.
  • Receive linguistics services and information documents translated into threshold languages.
  • Receive interpreter services, including sign language interpreters, at no cost to you. Receive oral interpretation services in your language.
  • Formulate advance directives.
  • Have access to family planning services, Federally Qualified Health Centers, Indian Health Services Facilities, sexually transmitted disease services, and Emergency Services outside of the SFHP network pursuant to the federal law.
  • File or voice a complaint, grievance or appeal if your cultural and linguistic needs are not met, or about the organization or the care provided.
  • Request a State Medi-Cal fair hearing including information on the circumstances under which an expedited fair hearing is possible.
  • Access minor consent services.
  • Receive written Member informing materials in alternative formats, including braille, large size print, and audio format upon request.
  • Receive information on available treatment options and alternatives, presented in a manner appropriate to your condition and ability to understand.
  • Have the meaning and limits of confidentiality explained to you. You understand that if you are a minor, your provider or other staff may need to talk with your parents or guardian about certain issues. If this happens, the information will be discussed fully with you as well.
  • Have confidential health records, except when disclosure is required by law or permitted in writing by you. With adequate notice, you have the right to review your medical records with your primary care provider.
  • Know about any transfer to another hospital, including information as to why the transfer is necessary and any alternatives available.
  • Get a referral from your primary care provider for a second opinion.
  • Be fully informed about SFHP’s appeals procedure and understand how to use it without fear of interruption of health care and present your appeal in person.
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.
  • Take part in establishing public policy of SFHP, by attending and/or joining the SFHP Member Advisory Committee and attending any SFHP Governing Board meeting.
  • Freedom to exercise these rights without adversely affecting how you are treated by San Francisco Health Plan,
    providers, or the State.
  • Make recommendations regarding SFHP’s member rights and responsibilities policy.
  • To disenroll upon request

Member Responsibilities

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.
  • 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.