Member's Rights & Responsibilities
Members have the right to:
- Receive information about the organization, its services, its practitioners and providers and member rights and responsibilities
- To be treated with respect and recognition of their dignity and right to privacy
- To participate with practitioners in making decisions about their health care
- To a candid discussion of appropriate or medically necessary treatment options of their conditions, regardless of cost or benefit coverage
- To voice complaints or appeals about the organization or the care it provides
- To make recommendations regarding the organization's member rights and responsibilities policies
Members have the responsibility to:
- Supply information (to the extent possible) that the organization and its practitioners and providers need in order to provide care
- To follow plans and instructions for care that they have agreed on with their practitioners
- To understand their health problems and participate in developing mutually agreed-upon treatment goals to the degree possible
Utilization Management Statement
- Utilization Management decision making is based solely on appropriateness of care
and service and existence of coverage. Your group does not specifically reward practitioners
or other individuals for issuing denials of coverage or service care. Financial
incentives for utilization management decision makers do not encourage decisions
that result in underutilization.
- If you want to obtain a copy of the decision making criteria utilized by your group for service decisions, this information is made available to participating providers and the public upon request by contacting our Member Services Department at (888) 445-0062. The group is only required to disclose the criteria or guidelines for specific procedures or conditions requested.
L.A. Care Nurse Advice Line
L.A. Care Health Plan wants to make sure its members get the best care and service
from your doctor. If you are sick, hurt or need health care advice, you can talk
to a nurse when you want, day or night by calling 1-800-249-3619.
You can ask a registered nurse (RN) questions about your children’s health or your
health any time. This service is open to L.A. Care Medi-Cal members and all L.A.
Care Healthy Families and Healthy Kids members.
Free Interpreter Services
L.A. Care Health Plan members can get free interpreter services. Ask your doctor's
office or pharmacy.
Free Interpreter Services
Anthem Blue Cross members can get free interpreter services. Ask your doctor's office
Language Services Available