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Home > Using Your Health Plan > Know Your Patient Rights

Know Your Patient Rights!

Young girl patient flexing arm Use your rights to get the best health care for you and your family. 

Most HMO or PPO health plan members in California have the following rights. Under health care reform, you have new rights. If you have questions about your rights in your health plan, look at your plan handbook or contact the agency that oversees your plan. And view tips on how to speak up for yourself.

 Topics on this page

 

Treatment

You have the right to get information about your health care  

Ask that your diagnosis and treatment plan be written down. When you ask questions about a treatment or medicine, you should get complete answers that you understand. Do not sign a consent form for treatment if you do not understand it. 

You have the right to get timely care

  • In most health plans, you can expect to see your primary care doctor within 10 business days and a specialist within 15 business days (these times are shorter if you need urgent care).
  • In most health plans, you can reach a qualified health professional by phone 24 hours a day, 7 days a week. If you need a call returned, you can expect a call within 30 minutes of leaving a message.
  • Learn more about the protections that HMO plan members have for getting timely access to care...

You have the right to

  • See a specialist if you need one.
  • Go to the emergency department if you need emergency care.
  • Get a second opinion about a serious health problem.

 

Doctors

You have the right to select a doctor you can trust and work with. You can...

  • Choose a primary care doctor in your plan's network.
  • Choose an internist, pediatrician, family doctor, or Ob/Gyn as your primary care doctor.
  • Change your doctor if you are not satisfied. (To change your doctor, call your health plan.)

 

Health plan costs and benefits

You have the right to know if a service is covered by your plan and what it will cost you. You can...

  • Call your health plan to find out if a test or procedure is covered and if it requires pre-approval.
  • Ask your health plan to help you clearly understand the services it covers.
  • Ask your health plan to explain your bills and make sure that the charges are correct.

 

File a complaint or appeal

You have the right to file a complaint (grievance) if you feel that you were wrongly denied care. You can...

  • Contact your health plan for help or to file a complaint.
  • Ask the health plan for a written explanation of the decisions about your complaint.
  • Request a fast (expedited) review of your complaint by the health plan, if your health problem is urgent.
  • Contact the agency that oversees your health plan to get assistance or file an appeal. Learn more about problems and complaints.

 

Health care reform - New rights!

On March 23, 2010, the Patient Protection and Affordable Care Act became law. This new health care reform law provides many new patient rights. Learn more about health care reform...

  • In most health plans, many vaccines, cancer screenings, and other preventive care services are now free, with no co-pay, co-insurance, or deductible. 
  • Health plans cannot refuse to cover children because they have a health problem or disability.
  • Starting in 2014, plans cannot charge you more or refuse to cover you because you have a health problem or are pregnant.
  • Plans cannot put a lifetime limit on how much care they will pay for if you get sick. And yearly limits will end in 2014.
  • Plans cannot cancel your coverage just because you get sick or make an unintentional mistake on your application.

 

Services in your language

You have the right to interpreter services at no cost to make sure you get quality treatment and care.

  • The law says that interpretation services must be provided for your doctor visits and for other kinds of medical care (such as laboratory visits, mental health care, and more).
  • Tell your health plan and doctor that you want services in your language.
  • Ask for an interpreter when you make your doctor appointment.
  • Ask for important information in your language. This includes consent forms, treatment plans, and information about your medicine. 

 

If your rights are violated

Contact the agency that oversees your health plan. For most Californians, this agency is one of these departments:

If you have questions or aren't sure what department oversees your plan, contact the California Consumer Assistance Program at 1-888-466-2219.

 

Resources

OPA materials: How to Use Your Health Plan Guide

Fact Sheet on Your New Rights

Languages provided by health plans

 

Related Topics

How to file a complaint

Language assistance

Disability assistance

Health care reform

Agencies that oversee health plans

 

Health Plan Problems?

For HMOs  888-466-2219
For PPOs   800-927-4357

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