Your Health Care Rights

No matter how you get your health coverage—whether it’s through your employer, Medi-Cal or Medicare, or you buy your own coverage—you have rights. Here are some tips that will help you take charge and get the health care you need:

• Understand your coverage. Read the document that describes your health plan benefits (often called an “Evidence of Coverage” (EOC) or “Summary Plan Description”). If you can’t find your EOC, call your health plan’s customer service department or contact your employer to get one.
  
• Keep good records. Get in the practice of keeping a written record of your contacts with your doctor, your medical group, and your health plan.
  
• Understand your medical condition and treatment options. Ask your doctor to fully explain your condition and treatment options. You can research your medical condition at local public libraries, through support groups, and on the Internet.

If you have a problem, don’t give up. Be persistent. Many problems can be resolved by taking these steps:

• Talk to your doctor. Your most important health care relationship is the one you have with your doctor, who should be your partner in health care. If you feel you can’t talk to your doctor, you have the right to change doctors.
• Contact the medical group. Most medical groups have patient assistance departments that can help you find a doctor, work out billing problems, or help you get referrals and authorizations for services.
• Call your health plan. A customer service representative at your health plan should be able to explain the health plan’s policies and procedures.
• Call the Health Rights Hotline, a free, independent service with counselors who will answer your questions and explain your health care rights. They can help you appeal a health plan or medical group decision. HRH is not affiliated with government or the health care industry. Call (916) 551-2100 or 1-888-354-4474.