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Rights and Responsibilities

Member Rights & Responsibility

When you became a member of Santa Barbara Select IPA, you joined a team that's dedicated to your health and well being-and, like any successful team, everyone has specific responsibilities. Our role is to be responsive to your individual needs and ensure your access to comprehensive, high-quality health care services. As members, you have responsibilities as well-along with rights that represent our commitment to you. 

 

Santa Barbara Select IPA Members have the right to:

Exercise these rights without regard to race, disability, ethnicity, gender, sexual orientation, economic creed, religion, national origin, cultural or educational background.

Be provided with information about Santa Barbara Select IPA, its services and the health care service delivery process.

Be informed of non-emergent cost of care, and receive an explanation of the member's financial obligations as appropriate, prior to incurring the expense (including co-payments, deductibles and co-insurance).

Examine and receive an explanation of bills generated for services delivered to the member.

Be informed of the name and qualifications of the physician who has primary responsibility for coordinating the member's care, and be informed of the names, qualifications, and specialties of other physicians, and non-physicians who are involved in the member's care.

Have 24-hour access to the member's primary care physician (or covering physician).

Receive complete information about the diagnosis, proposed course of treatment or procedure, alternate courses of treatment or non-treatment, the clinical risks involved in each, and prospects for recovery in terms that are understandable to the member regardless of cost or benefit coverage, in order to give informed consent or to refuse that course of treatment.

Actively participate in decisions regarding the member's health care and treatment plan. To the extent permitted by law, this includes the right to refuse any procedure or treatment. If the recommended procedure or treatment is refused, an explanation will be given addressing the effect that this will have on the member's health.

Be treated with respect and dignity.

Receive considerate and respectful care with full consideration of the member's privacy.

Receive confidential treatment of all communications and records associated with your health care.

Be informed of applicable rules in the various health care settings regarding member conduct.

Express opinions or concerns about Santa Barbara Select IPA or the care provided and offer recommendations for change in the health care service delivery process by contacting the Santa Barbara Select IPA Member Services Department.

Be informed of continuing health care requirements following office visits, treatments, procedures, and hospitalizations. This includes discussion of HMO requirements should the member seek care outside the network or plan to seek care outside the network.

Have all member rights apply to the person who has the legal responsibility to make health care decisions for the member.

Use of Emergency Services when you, as a prudent lay person acting reasonably, believe that an Emergency Medical Condition exists.

Voice complaints and appeals about your Health Plan or the care provided without discrimination and expect problems to be fairly examined and appropriately addressed.

Complete a Durable Power of Attorney for Health Care or other directive to a contracting medical provider.

Make recommendations regarding Santa Barbara Select IPA's Member Rights & Responsibilities policy.

 

Santa Barbara Select IPA Members have the responsibility to:


Be familiar with benefits and exclusions of your health plan coverage.

Provide the member's health care provider with complete and accurate information that is necessary for the care of the member (to the extent possible).

Be on time for all appointments and notify the provider's office as far in advance as possible for appointment cancellation or rescheduling.

Inform providers of your inability to understand the information given to you.

Do your part to improve your own health condition by following treatment plans, instructions and care that you have agreed on with your physician(s).

Contact your primary care physician (or covering physician) for any care that is needed after that physician's normal office hours.

Treat the health care providers and staff with respect.

Obtain an authorized referral form from your primary care physician for a visit to a specialist and/or receive any specialty care.

Be familiar and comply with Santa Barbara Select IPA's health care service delivery system access to routine, urgent, and emergent care.

Contact the Santa Barbara Select IPA Member Services Department or your health plan's customer services department regarding questions and assistance.

Respect the rights, property and environment of all physicians and Santa Barbara Select IPA providers, staff and other members.

Have all these responsibilities apply to the person who has legal responsibility to make health care decisions for the member.

Participate to the degree possible, in understanding your behavioral health problems and developing mutually agreed upon treatment goals.

Adhere to behavior that reasonably supports your treatment plan and the recommendations of your primary care physician or other contracting medical.