Rights & Responsibilities

MEMBER RIGHTS

1. The right to be treated with consideration, respect and recognition of their dignity and need for privacy, without regard to age, gender, race, sexual identity or orientation, family size or composition, or cultural, economic, educational, or religious background, or the source of payment for care, or medical condition or stage or illness.
2. The right to receive services in a culturally competent manner.
3. The right to change primary care providers or disenroll from the health plan for any reason.
4. The right to choose a primary care physician from within LaSalle’s/Health Plan’s network of primary care providers.
5. The right to receive information about LaSalle Medical Associates, its services, its practitioners, and providers.
6. The right to receive information regarding member rights and responsibilities.
7. The right to receive a paper copy of LaSalle Medical Associate’s Notice of Health Information Practices, upon request.
8. The right to know the name of the physician who has primary responsibility for coordinating the care and the names and professional relationships of other physicians and non-physicians who will see the patient.
9. The right to receive information about the illness, course of treatment and prospects for recovery in terms that the patient can understand.
10. The right to participate in decisions regarding his or her health care including the right to make the final determination in the course of action among clinically acceptable choices, and to the extent permitted by law, the right to refuse treatment if he or she chooses to do so.
11. The right to receive as much information about any proposed treatment or procedure as the patient may need in order to give informed consent or to refuse this course of treatment. Except in emergencies, this information shall include education regarding their health needs, findings of history and physical examination, and a description of the procedure or treatment, the medically significant risks involved in this treatment, alternate courses of treatment or non-treatment and the risks involved in each and to know the name of the person who will carry out any procedure or treatment.
12. The right to full privacy concerning medical care; case discussion with plan personnel, consultation, examination, and treatment are confidential and should be conducted discreetly. The patient has the right to be advised as to the reason for the presence of any individual.
13. The right to confidential treatment of all communications, records, and protected health information pertaining to medical care in the clinic. Written permission shall be obtained before the medical records can be made available to anyone not directly concerned with the care.
14. The right to request that communications of medical records information or protected health information is exchanged by alternate means or location.
15. The right to request a restriction on certain uses or disclosures of protected health information.
16. The right to authorize any disclosure of medical records or protected health information to any entities not covered by the Health Insurance Portability and Accountability Act, or third parties not involved in treatment, payment for services, or health care operations.
17. The right to amend or revoke previous authorizations for the use or disclosure of medical records information or other forms of protected health information.
18. The right to obtain an accounting of the disclosures of health information.
19. The right to receive a reasonable response to any reasonable request that he/she may make for service or information about his/her medical condition.
20. The right to request a second opinion about a medical opinion, and the right to request an external independent review.
21. The right to leave the hospital or clinic, even against the advice of the plan’s physicians.
22. The right to reasonable continuity of care, and to know in advance the time and location of an appointment as well as the person providing the care.
23. The right to be informed of continuing health care requirements following discharge from the clinic or hospital.
24. The right to voice complaints or grievances about his/her care, the provider, and or the Health Plan, and to have such grievances forwarded to the Clinic Administrator and or Health Plan for appropriate response, and to make appeals, and to receive timely resolution of complaints or grievances. The Member also has the right to file complaints directly with the California Department of Managed Health Care (DMHC), and/or the right to request a Medi-Cal Fair Hearing at any time.
25. The right to be advised if Clinic/personal physician proposes to engage in or perform human experimentation affecting care or treatment. The patient has the right to refuse to participate in such research projects.
26. The right to formulate advance directives.
27. The right to choose family planning services, treatment for sexually transmitted diseases and emergency services from any certified provider.
28. The right to review, request corrections to, insert an amendment to, and receive a copy of his/her medical records or other forms of protected health information.
29. The right to examine and receive an explanation of the bill regardless of source of payment.
30. The right to know which clinic or hospital rules and policies apply to the member’s conduct while a patient.
31. The right to have all member rights apply to the person who may have legal responsibility to make decisions regarding medical care on behalf of the patient.

MEMBER RESPONSIBILITIES

1. Knowing and understanding the terms, conditions and provision of the Health Plan and abiding by them.
2. Establishing and maintaining a patient-physician relationship.
3. Learning and caring about his/her own health, living a healthy lifestyle, with adequate exercise, good nutrition, and avoidance of harmful substances.
4. Participating actively in any decision making process regarding his/her own health.
5. Following preventive health care guidelines, treatment and plans and guidelines given by health care providers.
6. Providing accurate information to the physician, the Health Plan, and any other provider.
7. Scheduling or re-scheduling appointments, and informing the provider when it is necessary to cancel appointment.
8. Being considerate and respectful to Health Plan and physician staff and other patients.
9. Expressing grievances through the Health Plan’s grievance process.
10. Avoiding knowingly spreading disease to others.
11. Understanding that there are risks in receiving health care, and limits to what can be done medically.