Working with Medi-Cal Members & Understanding Member Rights
The following resources contain important information regarding working with SFHP Medi-Cal Members and their rights as members:
Provider Manuals and Resources
- Provider Manual for patient coordination & clinical staff
- Key information for Medi-Cal Providers is a brief overview of a Medi-Cal provider’s obligations.
- Community Resources for other services SFHP members may qualify for
The following section contains important information regarding Medi-Cal members’ rights to free interpreter services:
- Non-English speaking or limited English proficient Medi-Cal members have the right to receive oral interpreter services on a 24-hour basis at no cost to them.
- Interpreter services may be provided through an in-person interpreter or telephone language service.
- Your medical group is required to provide this service to SFHP Medi-Cal members.
- You must document a member’s preferred language (if other than English) in the medical record.
- You must document the request and refusal of language/interpretation services in the member’s medical record.
- You must discourage members from using friends, family, and minors as interpreters.
- Learn about options for accessing interpreter services in the Bay Area for your patients
- Click on this link for tips on working with interpreters
SFHP has health education materials available for our Medi-Cal members.
Click here to access SFHP’s Health Education Library. You may view and download various health education documents as well as useful resources including health education classes, videos, program, tips, and tools to share with your patients. Materials are available in English, Spanish, Chinese, and Vietnamese.
How to submit a grievance
If a member wants to file a complaint or grievance, providers may help them complete the SFHP Grievance Form. Grievance forms are available in English, Spanish, Chinese, Vietnamese, and Russian. Completed grievance forms can be submitted by mail, phone, or fax to:
San Francisco Health Plan
P.O. Box 194247
San Francisco, CA 94119
Phone: 1(800) 288-5555 or 1(415) 457-7800
Fax: 1(415) 547-7825
Please note, you may also refer the member to contact SFHP’s Customer Service at 1(415) 457-7800.
Providers are prohibited from discriminating against a SFHP member on the grounds that the member filed a grievance or appeal.
SFHP Medi-Cal members with Medi-Cal-only coverage do not have to pay for covered services. SFHP Medi-Cal members cannot be surcharged or balance billed for covered and authorized services. There are no copays, deductibles, or coinsurance for these members.
Discrimination is against the law. Providers shall not discriminate against SFHP Medi-Cal Members because of race, color, national origin, creed, ancestry, religion, language, age, marital status, sex, sexual orientation, gender identity, health status, physical or mental disability, or identification with any other persons or groups defined in Penal Code 422.56, in accordance with Title VI of the Civil Rights Act of 1964, 42 USC Section 2000d, rules and regulations promulgated pursuant thereto, or as otherwise provided by law or regulations. Acts of discrimination include:
- Denying any Member any Covered Services or availability of a Facility;
- Providing to a Member any Covered Service which is different, or is provided in a different manner or at a different time from that provided to other Members except where medically indicated;
- Subjecting a Member to segregation or separate treatment in any manner related to the receipt of any Covered Service;
- Restricting a Member in anyway in the enjoyment of any advantage or privilege enjoyed by others receiving any Covered Service, treating a Member differently from others in determining whether he or she satisfies any admission, Enrollment, quota, eligibility, membership, or other requirement or condition which individuals must meet in order to be provided any Covered Service;
- The assignment of times or places for the provision of services on the basis of the race, color, national origin, creed, ancestry, religion, language, age, marital status, sex, sexual orientation, gender identity, health status, physical or mental disability, or identification with any other persons or groups defined in Penal Code 422.56, of the participants to be served.