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California health
insurance
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Understand
California Health
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Health Care RightsYour California Health Care Rights
According to the DMHC
The California health
care system is very diverse
and convoluted.
We see some ways that
this will improve with
Health Reform and other ways
where it will only get more
complicated. It's good to
know your rights within the
system. Let's look at the
DMHC list of Rights and add
some real world comments.
Keep in mind that your
plan's type (i.e. HMO or
PPO) can seriously affect
how care is handled. Most of
these rights are pretty
straight forward but the
complaints section is
important.
Health Care Rights in
California
- You Have the Right to
Receive Care When You Need
It
- To have an appointment when
you need one. (if only this
were the case).
- To have an appointment with
a specialist when you need
one.
- To have continuity of care
if your doctor or medical
group leaves your plan. (HMO
doctor admin might make this
tough)
- To receive treatment for
certain mental health
conditions. (1999 Mental
health Parity really helped
on this front)
- To get a second doctor's
opinion.
- To know why your plan denies
a service or treatment. (The
EOB will always specify
which services were denied)
- You Have the Right to
Understand Your Health
Problems and Treatments
- To see a written diagnosis
(description of your health
problem).
- To give informed consent
when you have a treatment.
- You Have the Right to File a
Complaint and Ask for an
Independent Medical Review
- To file a complaint if you
have a problem with your
health plan.
- To ask for an Independent
Medical Review of a decision
your health plan makes about
your care.
- You Have the Right to Choose
Your Own Doctor
- To choose a doctor in your
health plan's network. (some
doctors are closed to new
patients and this will be an
impact going forward as
Health Reform swells the
insured ranks but not the
doctor's)
- To change to another doctor
in the network if you are
not satisfied with your
doctor. (Not too sure of the
practical application of
this if you have HMO doctor)
- To change your specialist or
mental health care provider
if you are not satisfied.
(similar note for HMO
doctors)
- To ask for a provider who
speaks your language if you
are not comfortable speaking
English (in some cases the
plan must provide an
interpreter).
- You Have the Right to See
Your Medical Records
- To get a copy of your
records (you may be charged
for the copying). (always
interesting to see what's in
the records. The application
process will occasionally
bring up medical record
notes that the
patient/applicant knew
nothing about).
- To add your own notes to
your records.
- To keep your medical records
private. ( HIPAA privacy
laws are pretty strict on
this now which is a good
thing)
- You Have the Right to Have
an Advanced Directive
An Advanced Directive tells
your doctor, family, and
friends about the health
care you want if you can no
longer make decisions for
yourself. It explains the
types of special treatment
you want or do not want. The
state Attorney General's
office has more information.
Call 1-800-952-5225. (This
is a big deal which many
people have not completed
and are unaware of until
it's too late)
Call us at 800-320-6269 with any
questions. Our services are free to you as
licensed health agents.