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Home > Health Plan Problems? > Your Patient Rights > Speak Up for Yourself

Speak Up for Yourself

Try to talk to your doctor if you are unhappy with your health care services. Or contact your health plan as soon as you become aware about a problem. Often, if you speak up early you can prevent a problem from becoming worse.

There are times when you need to do more to advocate for yourself. There are things you can do if you are not happy with your care or cannot get a needed service.

Topics on this page:


If your plan says a service is not covered

Your health plan may refer you to documents about your benefits. Ask the plan to send you the documents. Ask what page to look on, or ask them to highlight the part that says the service is not covered.

  • The Summary of Benefits is a short list of benefits and common charges.
  • The Evidence of Coverage (EOC) is an explanation of your benefits and services.
  • Most plans say that they do not cover experimental treatments. However, in California you can ask for an Independent Medical Review of this denial. Your condition must be serious.
  • If you want to dispute a denial or a delay in service, you can file a complaint with your health plan. Learn more about How to File a Complaint...

 

Ask a doctor to help you

If you are having trouble getting your health plan to approve a service or treatment, ask a doctor to help you. The doctor can help you explain why you need the care. This is important for a successful complaint. The doctor does not have to be part of your plan.


Tips for self-advocates

  • Act promptly.
  • Be persistent.
  • Take notes on your calls.
  • Get the names of people you talk to.
  • Have someone with you for support.
  • Ask to speak to a supervisor.
  • Denied care? Ask for the reason in writing.

 

Find a consumer assistant or advocate

Call a consumer assistance helpline or advocacy group for help and guidance. You can also ask your benefits office at work for help.

 

Resources

OPA materials: How to Use Your Health Plan Guide

OPA worksheet: My Complaint

 

Related Topics

Problems and Complaints

How to Talk to Your Doctor About a Complaint

Tips for Communicating with Your Plan

Find Local Consumer Assistance

 

Health Plan Problems?

Call 1-888-466-2219

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