CalOptima Direct Members Rights and Responsibilities

You have the right to:

  • Be treated with respect and dignity by all CalOptima and provider staff

  • Privacy and to have your medical information kept confidential

  • Get information about CalOptima, our providers, the services they provide and your member rights and responsibilities

  • Choose a doctor 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

You are responsible for:

  • 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

Download the free Adobe Reader.

Materials available on this Website in PDF format may require the free Adobe Reader to view. To download Adobe Reader for free from the Adobe Website, click here.

Text Size