Your rights under Medi-Cal managed care

Member Rights & Responsibilities

As an HPSJ Member, you have rights and responsibilities. Your rights include:

  • To receive copies of all documents used to make medical decisions free of charge. If you would like a copy of the benefit, guideline protocol, or other criteria that helped with the decision, please call Health Plan of San Joaquin at 1‐888‐936‐PLAN (7526) TTY/TDD 711.
  • To be treated with respect, giving due consideration to your right to privacy and the need to maintain confidentiality of your medical information.
  • To be provided with information about the plan and its services, including Covered Services.
  • To be able to choose a primary care doctor within Health Plan of San Joaquin’s network.
  • To participate in decision making regarding your own health care, including the right to refuse treatment.
  • To voice grievances, either verbally or in writing, about the organization or the care received.
  • To receive care coordination.
  • To request an appeal of decisions to deny, defer or limit services or benefits.
  • To receive oral interpretation services for your language.
  • To receive free legal help at your local legal aid office or other groups.
  • To formulate advance directives.
  • To request a State Hearing, including information on the circumstances under which an expedited hearing is possible.
  • To disenroll upon request. Members that can request expedited disenrollment include, but are not limited to, those receiving services under the Foster Care or Adoption Assistance Programs and those with special health care needs.
  • To access Minor Consent Services.
  • To receive written member-informing materials in alternative formats (such as braille, large-size print and audio format) upon request and in a timely fashion appropriate for the format being requested and in accordance with Welfare & Institutions Code Section 14182 (b)(12).
  • To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
  • To receive information on available treatment options and alternatives, presented in a manner appropriate to your condition and ability to understand.
  • To have access to and receive a copy of your medical records, and request that they be amended or corrected, as specified in 45 Code of Federal Regulations §164.524 and 164.526.
  • Freedom to exercise these rights without adversely affecting how you are treated by Health Plan of San Joaquin, your doctors or the State.
  • To have access to family planning services, Freestanding Birth Centers, Federally Qualified Health Centers, Indian Health Service Facilities, midwifery services, Rural Health Centers, sexually transmitted disease services and Emergency Services outside Health Plan of San Joaquin’s network pursuant to the federal law.

As an HPSJ Member, you have a responsibility to:

  • Be familiar with and ask questions about your health plan coverage. If you have questions you should contact Customer Service at 888.936.PLAN (7526) TTY/TDD 711.
  • Follow the advice and care procedures indicated by your doctors, Health Plan of San Joaquin and the program.
  • Request interpreter services at least five (5) business days before your scheduled appointment.
  • Call your doctor or pharmacy at least three (3) days before you run out of medication.
  • Treat your doctors and all their staff with respect. This includes being on time to appointments and calling to reschedule or cancel.
  • Understand that your doctor’s office may have limited seating for patients and caregivers only. Give accurate information to Health Plan of San Joaquin, your doctor’s office, and any other doctor in order to receive the best care possible.
  • Understand your health problems and work with your doctor to develop mutually agreed upon treatment goals.
  • Ask your doctor questions if you do not understand what they are saying.
  • Care for your own health. Live a healthy lifestyle, exercise, eat a good diet, and don’t Avoid knowingly spreading disease to others.
  • Report any wrong doing or fraud to Health Plan of San Joaquin.
  • Understand that there are risks in receiving health care and limits to what can be done for you medically.
  • Understand that it is a health care doctors duty to be efficient and fair in caring for you as well as other patients.

Your responsibilities include:

1. To work with your health care providers by:

  • Making positive health choices and to get health services when you need them.
  • Following his or her instructions.
  • Taking all medications you are asked to take.

2. Giving correct information to your doctors and to us.

3. To keep appointments that you or your doctor have made.

Commitment to Quality

We are committed to quality and to ensuring you get the best health care.

Posted on June 16th, 2015 and last modified on June 8th, 2021.