HEALTH RIGHTS HOTLINE Independent Assistance For Health Care Consumers

Take Charge of Your Health Care

The HEALTH RIGHTS HOTLINE is a free, independent source of information and assistance for consumers who have questions or concerns about getting health care.

We believe the person who should be in charge of your health care is you.

KNOW YOUR RIGHTS
Your rights as a health care consumer come from many sources, starting with the contract between you (or your employer) and your health plan. This legal document - usually called the "Evidence of Coverage" or EOC - describes some of those rights; others are guaranteed by state and federal law. While the scope and type of care and services differ with each health plan, there are basic rights that apply in most cases:

You have the right to be in charge of your health care.

No matter which health plan you are in, you are ultimately in charge of your health care. You have the right to be informed about your diagnosis and treatment options as well as their potential risks, and the right to accept or refuse that treatment. You also have the right to confidentiality in your treatment and privacy regarding your medical records.

You have the right to be informed.

No matter how you get health care coverage - through an individual policy you purchase, through your work, or through a public program such as Medicare, Medi-Cal or CHAMPUS - your benefits and rights are spelled out in your Evidence of Coverage. Your EOC is your most important information resource. Read it, ask questions if you don't understand it, and keep it where you can find it easily. Refer to the Health Rights Hotline action guide on Understanding Your Health Plan Agreement.

You have the right to choose.

Health plans often require you to get basic care from a primary care physician (often called a PCP). Whether your health plan calls your doctor a PCP or you call him or her your family doctor, medical services begin here. The most important choice you can make is to select a doctor who is qualified, located near your home or work, and someone you trust. Regardless of your health plan, you have the right to choose your doctor - and change your doctor - usually from among a list of doctors approved by your health plan.

You have the right to good - and timely - health care.

You deserve to be treated with respect in a clean and safe environment and to receive the care you need from qualified doctors and other health care providers. You have the right to make an appointment when you need one. Refer to the Health Rights Hotline action guide on Referrals and Approvals for Medical Services.

You have the right to have your questions answered and problems handled quickly.

Most health plans have a customer service department (also called "member services") to answer your questions and resolve problems. If you have questions about your coverage or your health plan's procedures, you have the right to prompt and courteous answers. If a treatment you are seeking has been denied, you have the right to appeal that decision. Refer to the Health Rights Hotline action guide on What To Do If You Have A Problem With Your Health Plan and How To Appeal a Health Plan or Medical Group Decision.

KNOW YOUR RESPONSIBILITIES

While the Health Rights Hotline is here to help you understand and exercise your rights, we are also here to help you understand your responsibilities.

You have the responsibility to know your health plan.

Your main responsibility is to understand what is and is not covered by your health plan and how the health plan operates. Your Evidence of Coverage describes your benefits in detail. If there are parts you don't understand, call your health plan's customer service department and ask to have them explained.

You have the responsibility to take an active role in your health care.

Taking an active role in your health care means providing correct information and medical histories and keeping good records. It also means that your personal lifestyle choices may affect your health. Try to understand as much as you can about your medical condition. If you have questions, ask your doctor. There are no "dumb" questions when it comes to your health.

You have the responsibility to communicate to your doctor.

Just as you have the right to be in charge of your health care, you also have the responsibility to clearly communicate your decisions. If you don't fully understand the cost or benefits of a recommended treatment, it's your responsibility to say so. If you choose not to follow a recommended treatment plan, it is your responsibility to let your doctor, nurse or other health care provider know.

You have the responsibility to keep your end of the bargain.

Common courtesy - including showing consideration for your doctor and fellow patients and keeping scheduled appointments - is part of keeping your commitment. So is paying your share for treatment. Finally, you are responsible for following the course of treatment you and your doctor have agreed upon.

TAKE CHARGE OF YOUR HEALTH CARE
The first things you can do before any problems come up, are:

Understand your coverage.

You should have a copy of your Evidence of Coverage that describes plan benefits, policies and procedures. If you can't find your EOC, call your health plan's customer service department.

Keep good records.

Get in the practice of keeping a written record of your contacts with your doctor and your health plan. This will help you get what you need from your health plan if a problem develops. Medical records, health plan documents and billing records should be organized and easy to find. It is also important to understand and be able to describe your medical condition in detail.

If you are confused or have a problem, take the following steps:

First, talk to your doctor.

Your most important relationship is the one you have with your doctor, nurse or other health professional who acts as your partner in health care. If you have questions or a problem, talk to your doctor.

Next, call your health plan.

A customer service representative at you health plan can explain the health plan's policies and procedures. Many problems can be resolved if you start with your health plan.

Then, if you still have questions or concerns, call the HEALTH RIGHTS HOTLINE.

The Health Rights Hotline is a totally independent, free service which provides information and assistance to consumers in the Sacramento, California area. Experienced counselors answer questions about your rights and explain how to exercise them. We also connect you with other resources that can help you. In some cases, we may take a more active role, such as talking to your health plan or doctor to help you resolve your problem.