Rights and Responsibilities

As a member of CalOptima, you have certain rights and responsibilities.

You have the right to:

  • Be treated with respect and dignity by all CalOptima, health network, and provider staff
  • Privacy and to have your medical information kept confidential
  • Get information about CalOptima, our health networks, our providers, the services they provide, and your member rights and responsibilities
  • Choose a primary care provider (PCP) within CalOptima's network
  • Talk openly with your health care providers about medically necessary treatment options, regardless of cost or benefit
  • Help make decisions about your health care, including the right to say “no” to medical treatment
  • Voice complaints or appeals, either verbally or in writing, about CalOptima or the care we provide
  • Get oral interpretation services in the language that you understand
  • Make an advance directive
  • Access family planning services, Federally Qualified Health Centers, Indian Health Service Facilities, sexually transmitted disease services and emergency services outside CalOptima's network
  • Ask for a State Hearing, including information on the conditions under which your State Hearing can be expedited
  • Have access to your medical record, and where legally appropriate, get copies of, update or correct your medical record
  • Access minor consent services
  • Get written member information at no cost in braille, large-size print and other formats upon request and in a timely manner appropriate for the format being requested
  • Be free from any form of control or limitation used as a means of pressure, punishment, convenience or revenge
  • Get information about your medical condition and treatment plan options in a way that is easy to understand
  • Make suggestions to CalOptima about your member rights and responsibilities
  • Freely use these rights without negatively affecting how you are treated by CalOptima, providers or the state

Your responsibilities

  • Knowing, understanding and following your member handbook
  • Understanding your medical needs and working with your health care providers to create your treatment plan
  • Following the treatment plan you agreed to with your health care providers
  • Telling CalOptima and your health care providers what we need to know about your medical condition so we can provide care
  • Making and keeping medical appointments and telling the office when you must cancel your appointment
  • Learning about your medical condition and what keeps you healthy
  • Taking part in health care programs that keep you healthy
  • Working with and being polite to the people who are partners in your health care
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