Member Rights and Responsibilities

Members are informed of their rights and responsibilities through the Member Handbook. California Health & Wellness network providers are also expected to respect and honor Member's rights.

California Health & Wellness Members have the following rights:

  • Ask for and receive information about California Health & Wellness, our services, participating practitioners, providers, Member rights and responsibilities, and how to use California Health & Wellness' benefits.
  • Be treated in a courteous and respectful manner that reflects recognition of your privacy and dignity as a person.
  • Wait no more than 30 seconds to speak to a Member Services representative during California Health & Wellness' normal business hours.
  • Upon request receive information about California Health & Wellness staff and staff qualifications for health management programs.
  • Receive interpreter services at no cost to you. You also have the right not to use family members or friends as interpreters. Minors should not be used as interpreters unless it is a medical emergency.
  • Receive medically necessary covered services without regard to race, religion, age, gender, national origin, disability, sexual identity or orientation, 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 California Health & Wellness network as stated in Federal law.
  • Receive emergency or urgently needed services outside the California Health & Wellness network or when authorized by California Health & Wellness.
  • 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
  • Choose a primary care doctor within the California Health & Wellness network.
  • To have a confidential relationship with your doctor.
  • Receive information from California Health & Wellness that you can understand.
  • Upon request receive Member information materials in alternative formats including Braille, large print, and audio.
  • Make recommendations about California Health & Wellness' Member rights and responsibilities policies.
  • Participate with your doctors and other practitioners in decision making about your own health care.
  • Talk openly with your doctor and other practitioners about your medical condition and appropriate or medically necessary treatment options for your condition regardless of the cost or what your benefits are.
  • Decide about your care, including the decision to stop treatment or 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 California Health & Wellness regarding advance directives and to receive information from California Health & Wellness 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 California Health & Wellness keeps your information confidential.
  • Make complaints and appeals without discrimination about California Health & Wellness, our providers, or your care. California Health & Wellness will help you with the complaint and appeal process. 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. Medi-Cal Members have the right to request a State Fair Hearing or an expedited Fair Hearing for urgent cases. Call the Department of Social Services Public Inquiry and Response Unit at 1-800-952-5253 or TTY 1-800-952-8349.
  • Request an Independent Medical Review from the Department of Managed Health Care (DMHC) if you disagree with California Health & Wellness' decision to deny, delay, or modify a service that your doctor or other practitioner 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, see section Member Satisfaction of this EOC, or call California Health & Wellness Member Services at 1-877-658-0305 (For TTY, contact California Relay by dialing 711 and provide the 1-877-658-0305 number).
  • Have California Health & Wellness act as your patient advocate.
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.
  • Disenroll from California Health & Wellness.
  • Request a second opinion about a medical condition.
  • File a grievance with California Health & Wellness if your language needs are not met.
  • 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.

California Health & Wellness Members have the following responsibilities:

  • Be familiar with and ask questions about your health plan coverage. If you have a question about your coverage, call California Health & Wellness Member Services at 1-877-658-0305 (For TTY, contact California Relay by dialing 711 and provide the 1-877-658-0305 number).
  • Follow the advice and care procedures indicated by your doctor, California Health & Wellness, and the program. If you have a question about these procedures, call California Health & Wellness Member Services at 1-877-658-0305 (For TTY, contact California Relay by dialing 711 and provide the 1-877-658-0305 number).
  • 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 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 the extent possible) to California Health & Wellness, your doctor and any other provider in order to help you receive the best care possible.
  • Understand your health problems and work with your doctor and other practitioners in developing mutually agreed-upon treatment goals, to the degree possible.
  • Ask your doctor questions if you do not understand what they are saying to you.
  • Work with your doctor to make plans for your health care.
  • Follow California Health & Wellness and instructions for care that you have agreed on with your doctors and other practitioners.
  • Immunize your children by age two (2) years and always keep your children's immunizations up to date.
  • Call your doctor when you need routine or urgent health care.
  • Care for your own health. Live a healthy lifestyle, exercise, eat a good diet, and don’t smoke.
  • Avoid knowingly spreading disease to others.
  • Use California Health & Wellness' grievance process to file a complaint. Call California Health & Wellness Member Services at 1-877-658-0305 (For TTY, contact California Relay by dialing 711 and provide the 1-877-658-0305 number) to file a complaint.
  • Report any wrong doing or fraud to California Health & Wellness by calling the California Health & Wellness Member Service at 1-877-658-0305 (For TTY, contact California Relay by dialing 711 and provide the 1-877-658-0305 number) 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.