Members Rights and Responsibilities

• Be treated with respect and dignity.

• Choose your primary care provider from our Provider Directory.

• Get appointments within a reasonable amount of time.

• Participate in candid discussions and decisions about your health care needs, including appropriate or medically necessary treatment options for your condition(s), regardless of cost and regardless of whether the treatment is covered by this health plan.

• Have a confidential relationship with your provider.

• Have your records kept confidential. This means we will not share your health care information without your written approval or unless it is permitted by law.

• Voice complaints or appeals, either verbally or in writing, about CalOptima, or about health care services you received.

• Receive information about CalOptima, our services, our providers and your rights and responsibilities.

• Make recommendations about your rights and responsibilities.

• See your medical records.

• Get services from providers outside of our network in an emergency.

• Request an interpreter at no charge to you.

• Use interpreters who are not your family members or friends.

• File a complaint if your linguistic needs are not met.

• Give your providers, your Health Network and CalOptima correct information in order to provide care.

• Understand your health problem(s) and participate in developing treatment goals, as much as possible, as well as follow treatment plans agreed to with your provider.

• Always present your Member Identification Card when getting services.

• Use the emergency room only in cases of an emergency or as directed by
  your provider.

• Make and keep appointments and inform your provider at least 24 hours in advance when an appointment must be cancelled.

• Ask questions about any medical condition and make certain you understand your provider's explanations and instructions.

• Help CalOptima and its providers maintain accurate and current medical records by providing timely information regarding changes in address, family status and other health coverage.

• Notify CalOptima as soon as possible if a provider bills you inappropriately or if you have a complaint.

• Treat all CalOptima personnel and health care providers respectfully
  and courteously.