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As a Medi-Cal member, you have the right:
- To be treated with respect, giving due consideration to your right to privacy and the need to maintain confidentiality of your medical information
- To be provided with information about the plan and its services, including covered services
- To be able to choose a primary care physician (PCP) within the Aetna® network
- To participate in decision making regarding your own health care, including the right to refuse treatment
- To voice grievances, either verbally or in writing, about the organization or the care received
- To receive oral interpretation services for your language
- To formulate advance directives
- To have access to family planning services, Federally Qualified Health Centers, Indian Health Service facilities, sexually transmitted disease services and emergency services outside the Aetna network, pursuant to the federal law
- To request a state hearing and get information on the circumstances under which an expedited hearing is possible
- To have access to and, where legally appropriate, receive copies of, amend or correct your medical record
- To disenroll from your Medi-Cal plan upon request
- To access Minor Consent Services
- To receive written member-informing materials in alternative formats (including Braille, large-size print and audio formats) upon request and in a timely fashion appropriate for the format being requested and in accordance with W & I Code Section 14182 (b)(12)
- To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation
- To receive information on available treatment options and alternatives, presented in a manner appropriate to your condition and ability to understand
- To receive a copy of your medical records and request that they be amended or corrected, as specified in 45 CFR §164.524 and 164.526
- To be free to exercise these rights without adversely affecting how you are treated by Aetna, providers or the state
As a Medi-Cal member, you are responsible for:
- Reading your member handbook. It tells you about our services and how to file a grievance or appeal.
- Using your Medi-Cal ID cards when you go to your appointments or get services. Do not let anyone else use your cards.
- Knowing the name of your PCP and your care manager, if you have one.
- Knowing about your health care. And understanding the rules for getting care.
- Telling us and the Department of Health Care Services (DHCS) when you make changes to your address, telephone number, family size, employment status and other information that might affect enrollment. You must also tell us if you move out of state.
- Understanding your health problems and participating in developing mutually agreed-upon treatment goals, to the degree possible.
- Being respectful to the health care providers who are giving you care.
- Scheduling your appointments, being on time and calling if you are going to be late to or miss your appointment. If you need to cancel an appointment, it must be done at least 24 hours before your scheduled visit.
- Using the emergency room for true emergencies only.
- Giving your health care providers all the information they need.
- Telling us and DHCS about your concerns, questions or problems.
- Asking for more information if you do not understand your care or health condition.
- Following your health care provider’s advice.
- Scheduling wellness check-ups. Members under 21 years of age need to follow the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) schedule.
- Getting care as soon as you know you are pregnant. And keeping all prenatal appointments.
- Telling us about any other insurance you have.
- Telling us if you are applying for or getting any other health care benefits.
- Bringing vaccine records to all appointments for children under 18 years old.
- Giving your doctor a copy of your living will or advance directive.
- Keeping track of the cost-sharing amounts you pay.
You can find out more about your rights and responsibilities by calling Member Services at 1-855-772-9076 (TTY: 711).
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You can find out more about your rights and responsibilities in your member handbook.