Our Members Rights & Responsibilities
Good health care starts with having a good relationship with your doctors, their staff and your health plan.
As a CenCal Health member, you have many rights that we want you to know about. You also have responsibilities and both are very important for you to know and understand. In the sections on this page, we have outlined your rights as a CenCal Health member and just as importantly, your responsibilities.
You as a CenCal Health Member, Have the Right to:
- Receive information about the Health Plan, the providers and the health services available to you;
- Be treated with respect and dignity by your health care providers and Health Plan staff;
- Choose your Primary Care Provider (doctor) from our Provider Directory;
- Get appointments within a reasonable amount of time;
- Have the privacy and confidentiality of your records and your relationship with your doctor protected (this means we will not share your health care information without your written approval or unless it is required by law);
- Receive information about your medical condition in terms you can understand in order to participate in making decisions about your care with your health care provider;
- Have an open discussion of appropriate treatment options, including the right to refuse treatment for your condition, regardless of cost and benefit coverage;
- Make recommendations about the Health Plan’s Rights and Responsibilities policies;
- Request a copy of your medical records and/or request a change or correction where legally appropriate;
- Obtain needed interpreter services at no charge when receiving covered medical services and to be able to file a complaint if your language needs are not met;
- Receive medical services from an Indian Health Clinic without approval from the Health Plan if you are a Native American Indian;
- File a complaint or appeal (by phone or in writing) about the Health Plan or health care provided and be assured by CenCal Health that there will be no discrimination or retaliation against you for filing a complaint;
- Receive member materials (letters, member handbook, provider directories and other important information) that have been translated into the threshold language. For CenCal Health those languages are Spanish and English;
- Receive and complete an advance directive. This means you can complete a form that lets you have a say about how you want to be treated if you get very sick. You will also be notified if there are any changes to this law;
- Freedom to exercise these rights without adversely (negatively) affecting how you are treated by the Health Plan, providers, or the State.
You as a CenCal Health Member, Have the Responsibility to:
- Learn how to use the Health Plan and provide the information to the Health Plan that is needed to give you the best care possible;
- Follow the instructions and treatment plan you have agreed on with your health care provider;
- Cooperate with your providers and treat your providers and Health Plan staff with courtesy and respect;
- Always present your member identification card when getting services;
- Help CenCal Health keep correct records by providing timely information regarding changes in address, family status, and other health care coverage;
- Notify CenCal Health as soon as possible if a provider bills you inappropriately;
- Understand your health problems and take part in making a treatment plan with your provider that you both agree on;
- Be on time for your appointments and inform the provider’s office if you must cancel at least twenty-four (24) hours in advance;
- Call your Primary Care Provider first when needing medical care, except in an emergency;
- Follow the recommendations for preventive care, yearly check-ups and a healthy lifestyle.