Rights and Responsibilities as a Member of IEHP Medi-Cal

As an IEHP Member you have the following rights:

  • Receive information about your rights and responsibilities as an IEHP Member.
  • Be treated with respect and courtesy. IEHP recognizes your dignity and right to privacy.
  • Receive information about IEHP, its programs and services, its Doctors, its providers, and health care facilities.
  • Receive interpreter services at no cost to you.
  • Your IEHP Doctor cannot charge you for covered health care services, except for required co-payments.
  • Receive medically necessary covered services without regard to race, religion, age, gender, national origin, mental or physical disability, sexual identity or orientation, genetic information, source of payment, family composition or size, or medical condition or stage of illness.
  • Receive family planning services, services at Federally Qualified Health Centers or Indian Health Centers, sexually transmitted disease (STD) services, and emergency services outside the IEHP network as stated in Federal law (Medi-Cal Members).
  • If you are under a Doctor’s care for an acute condition, serious chronic condition, pregnancy, terminal illness, newborn care, or a scheduled surgery, you may ask to continue seeing your current Doctor. To make this request, or if you have any concerns about your continuity of care, please call IEHP Member Services at 1-800-440-IEHP (4347).
  • If you have been receiving care from a health care provider, you may have a right to keep your provider for a designated time period. Please contact IEHP Member Services at 1-800-440-IEHP (4347). If you have further questions, you are encouraged to contact the Department of Managed Health Care, which protects HMO consumers, by telephone at its toll free number, 1-888-HMO-2219, or at a TDD number for the hearing impaired at 1-877-688-9891, or online at www.hmohelp.ca.gov.
  • Receive emergency or urgently needed services outside the IEHP Network.
  • Receive emergency care whenever necessary and wherever you need it.
  • Receive sensitive services, such as family planning or mental health care in a confidential way.
  • Access minor consent services (Medi-Cal).
  • Choose a primary care Doctor within the IEHP Network.
  • If your Primary Care Doctor changes, your IEHP benefits and required co-payments will stay the same.
  • Receive information from IEHP that you can understand.
  • Receive Member informing materials in alternative formats, including Braille, large print, and audio.
  • Make recommendations about IEHP Members’ rights and responsibilities policies.
  • Participate with Doctors in decision making about your own health care.
  • Talk with your Doctor about your medical condition and appropriate or medically necessary treatment options regardless of the cost or what your benefits are. Members who are not able to talk with their Doctor about decision making have the right to be represented by parents, guardians, family members or other conservators. Receive information on available treatment options and alternatives, presented in a manner appropriate to the Member’s condition and ability to understand. 
  • Decide about your care, including the decision to stop treatment, services, or stop participating in health management programs.
  • Decide in advance how you want to be cared for in case you have a life-threatening illness or injury.
  • Be informed by IEHP regarding advance directives, and to receive information from IEHP regarding any changes to that law. The information shall reflect changes in state law regarding advance directives as soon as possible, but no later than 90 days after the effective date of change.
  • Review, request corrections to, and receive a copy of your medical records (your Doctor may charge a fee for copies of records and other forms).
  • Keep your personal and medical information and records confidential, unless you say differently, and know how IEHP keeps your information confidential.
  • Complain about IEHP, its providers, or your care. IEHP will help you with the process. You may appeal decisions made by IEHP or your Medical Group. You have the right to choose someone to represent you during the grievance process and for your complaints and appeals to be reviewed as quickly as possible and be told how long it will take. Medical Members have the right to request a State Fair Hearing or an expedited Fair Hearing for urgent cases. Member’s have the right to have benefits continue pending the resolution of the appeal and receive how to request benefits continue. Call the Department of Social Services Public Inquiry and Response Unit at 1-800-952-5253 or TTY 1-800-952-8349.
  • Have IEHP act as your patient advocate.
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.
  • Medical recipients can stop being IEHP Members (disenroll) at anytime, for any reason. If you want to disenroll, call IEHP Member Services at 1-800-440-4347 or Health Care Options at 1-800-430-4263 to get disenrollment information.
  • IEHP will honor authorization for services already approved for you. If you have any authorization pending approval, if you are in the middle of treatment, or if specialty care has been scheduled for you by your current Doctor, contact IEHP to help you coordinate your care during this transition time. Call IEHP Member Services at 1-800-440-IEHP (4347)
  • Request a second opinion about a medical condition.
  • File a grievance with IEHP if your linguistic needs are not met
  • Request an Independent Medical Review from the Department of Managed Health Care (DMHC) if you disagree with IEHP’s decision to deny, delay, or modify a service that your Doctor requests.
  • Request an External Independent Review if a service or therapy was denied on the basis that it was considered experimental or investigational. If you have any questions about these procedures, call IEHP Member Services at 1-800-440-IEHP (4347). TTY users should call 1-800-718-4347
  • If you are a Native American Indian, you have the right to not enroll in a plan, not be restricted by a plan in your right to access Indian Health Facilities, and to disenroll from a plan without cause.

As a Member of IEHP, you have the responsibility to:

  • Be familiar with and ask questions about your health plan options, your health plan coverage limitations and exclusions, rules about the use of network providers, coverage and exclusions, rules, appropriate process to obtain addition information and process to appeal coverage decisions. If you have a question about your coverage, call IEHP Member Services at 1-800-440-IEHP (4347). TTY users should call 1-800-718-4347.
  • Follow the advice and care procedures indicated by your doctor, IEHP and the Healthy Kids, or Healthy Families program. If you have a question about these procedures, call IEHP Member Services at 1-800-440-IEHP (4347). TTY users should call 1-800-718-4347.
  • Request interpreter services at least 5 working days before a scheduled appointment.
  • Call your Doctor or pharmacy at least 3 days before you run out of medicine.
  • Cooperate with your Doctor and staff and treat them and other patients with respect. This includes being on time for your visits or calling your Doctor if you need to cancel or reschedule an appointment.
  • Understand that your Doctor’s office may have limited seating for patients and caregivers only.
  • Give accurate information to IEHP, your Doctor, and any other provider. This helps you receive better care.
  • Understand your health care needs and be part of your health care decisions. Ask your doctor questions if you do not understand.
  • Work with your Doctor to make plans for your health care.
  • Follow the plans and instructions for care that you have agreed on with your Doctor.
  • Notify IEHP and your Doctor if you want to stop the plans and instructions you have agreed on or want to stop participating in health management programs.
  • Immunize your children by age 2 years and always keep your children’s immunization up to date.
  • Call your Doctor when you need routine or urgent health care.
  • Care for you own health. Live a healthy lifestyle, exercise, eat a good diet, and don’t smoke.
  • Avoid knowingly spreading disease to others.
  • Use IEHP’s grievance process to file a complaint. Call IEHP Member Services at 1-800-440-IEHP (4347). TTY users should call 1-800-718-4347 to file a complaint (grievance or appeal).
  • Report any wrongdoing or fraud to IEHP by calling the Compliance Hotline at (866) 355-9038 or the proper authorities.
     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 provider’s duty to be efficient and fair in caring for you as well as other patients.
  • Make a good –faith effort to pay your health care bills (Premiums, co-pays and non-covered services where applicable).
  • Follow administrative and operational procedures at IEHP, its providers and Government health benefits programs.