Alliance Member Rights and Responsibilities
What are my rights and responsibilities as an Alliance member?
As a member of the Alliance, you have certain rights and responsibilities.
These are your rights as a member of the Alliance:
- To be treated with respect and dignity, 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 health plan and its services, including covered services, practitioners, and member rights and responsibilities.
- To get fully translated written member information in your preferred language, including all grievance and appeals notices.
- To make recommendations about the Alliance’s member rights and responsibilities policy.
- To be able to choose a primary care provider within the Alliance’s network.
- To have timely access to network providers.
- To participate in decision making with providers 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 you got.
- To know the medical reason for the Alliance’s decision to deny, delay, terminate or change a request for medical care.
- To get care coordination.
- To ask for an appeal of decisions to deny, defer or limit services or benefits.
- To get no-cost interpreting and translation services for your language.
- To get free legal help at your local legal aid office or other groups.
- To formulate advance directives.
- To ask for a State Hearing if a service or benefit is denied and you have already filed an appeal with the Alliance and are still not happy with the decision, or if you did not get a decision on your appeal after 30 days, including information on the circumstances under which an expedited hearing is possible.
- To disenroll (drop) from the Alliance in Mariposa and Santa Cruz counties and change to another health plan in the county upon request.
- To access minor consent services.
- To get no-cost written member information in other formats (such as braille, large-size print, audio, and accessible electronic formats) upon request and in a timely fashion appropriate for the format being requested and in accordance with Welfare and Institutions (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 truthfully discuss information on available treatment options and alternatives, presented in a manner appropriate to your condition and ability to understand, regardless of cost or coverage.
- To have access to and get a copy of your medical records, and request that they be amended or corrected, as specified in 45 Code of Federal Regulations (CFR) sections 164.524 and 164.526.
- Freedom to exercise these rights without adversely affecting how you are treated by the Alliance, your providers or the state.
- To have access to family planning services, Freestanding Birth Centers, Federally Qualified Health Centers, Indian Health Clinics, midwifery services, Rural Health Centers, sexually transmitted infection services, and emergency services outside the Alliance’s network pursuant to the federal law.
Alliance members have these responsibilities:
- Know the Alliance’s rules and follow them.
- Tell your doctor about your health conditions, both now and in the past.
- To follow plans and have instructions for care that they have agreed to with their practitioners.
- To understand their health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible.
- Keep your appointments. If you have to cancel an appointment, let the office know 24 hours before you were scheduled to see the doctor.
- Be kind and polite to your doctors, their staff and to Alliance staff.
- Keep your Alliance ID and Medi-Cal BIC cards with you at all times and show your cards when you get care.
- Follow the rules of any other health insurance you have.
- Use the emergency room only for emergency care.
- Call your county Medi-Cal office if you move or change your phone number. If you receive Supplemental Security Income (SSI), call the local Social Security Office.
- Call your local county services office to update any other health insurance you have or no longer have. To update other insurance information by phone, call:
Mariposa County
1-800-549-6741
1-209-966-2000
Merced County
1-855-421-6770
1-209-385-3000
Monterey County
1-877-410-8823
San Benito County
1-831-636-4180
Santa Cruz County
1-888-421-8080
To update other insurance information online, go to the California Department of Health Care Services (DHCS) website: https://www.dhcs.ca.gov/services/Pages/TPLRD_OCU_cont.aspx