10 Rights for HMO Patients
- You have the right to see a primary care physician who is located near you. Your HMO must assign you to a primary care physician who is located within 15 miles (or a 30 min drive) of your home or workplace.
- You have the right to a second opinion. If you disagree with the diagnoses or the way or the way your doctor proposes to treat you, and have discussed the matter with your doctor, you may request to see another physician for a second opinion. In many cases the HMO must pay for a second opinion.
- You have the right to be referred to a specialist when medically necessary. Your HMO must provide a referral to a qualified specialist when it is medically necessary for you to see one.
- You have the right to select an obstetrician/gynecologist as your primary care physician. If you are a woman, your HMO must permit you to see a participating obstetrician/gynecologist without obtaining a referral from your primary care physician.
- You have the right to a quick response when requesting authorization for medical referral. In most cases your HMO must provide an answer to your physicians requesting authorization for a medical referral. In most cases your HMO must provide an answer to your physician’s requests for a treatment authorization within five business days of the HMO’s receipt of the request (or 72 hours if the request is urgent).
- You have the right to file a grievance with your HMO. If you are dissatisfied with the health care that you received from your HMO, you have the right to file a grievance with your HMO. The HMO must resolve the grievance within 30 days (or within three days if the grievance is urgent).
- You have the right to receive emergency care without prior authorization. If you reasonably believe that you need immediate care to avoid placing your health at serious risk, you may seek emergency care by dialing “911” or by going to the nearest emergency faculty without seeking prior authorization from your HMO.
- You have the right to uninterrupted health care. If you have to change HMO’s or you doctor is no longer under contract with your HMO during the course of treatment, your HMO must have policies in place to grantee that you will not suffer from an interruption in medically necessary care.
- You have the right to inspect your medical records kept by your provider. You can also review your own medical records. If you believe they are incomplete or incorrect, you have the right to add written addendum with respect to any item or statement in your records. There may be a fee to review you medical records.
- You have the right to contact the California Department of Managed Health Care’s HMO Help Center for assistance, toll free at 888-HMO-2219 or TDD 877-688-9890if you can’t resolve a problem with you HMO.
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