Wednesday, May 24, 2017

Patient Resources

Cover California
Covered California makes it simple and more affordable for you to get high-quality health insurance that can't be canceled or denied because of a pre-existing medical condition or if you get sick,” and link: www.coveredca.com

Advance Health Care Directive Kits
California law provides the ability to insure patients’ health care wishes are known if they become unable to make these decisions themselves. The California Medical Association publishes an Advance Health Care Directive Kit, which includes an Advance Health Care Directive form and wallet cards as well as information which answers the questions commonly asked about Advance Directives. To order click here.

Do Not Resuscitate Form (DNR)
The Pre-Hospital Do Not Resuscitate (DNR) form developed by the California Emergency Medical Services Authority in conjunction with the California Medical Association instructs EMS personnel to forgo resuscitation attempts in the event of a patient's cardiopulmonary arrest. Click here for more information and DNR form.

End of Life Care/POLST
Physician’s Orders for Life-Sustaining Treatment (POLST) is a standardized medical form on bright pink paper that families must have available to show emergency responders what specific treatments a seriously ill patients does or does not want. Print on 65# cover ultra pink card stock

Find A Community Clinic
California Primary Care Association (CPCA) is the statewide leader and recognized voice representing the interests of California community clinics and health centers and their patients. CPCA represents more than 600 clinics and health centers providing quality health care services, particularly for low-income, uninsured and underserved Californians who might otherwise not have access to health care. Visit www.cpca.org to locate a community clinic near you.

Healthcare Reform
Knowing what is in the Affordable Care Act (ACA) may help you make smart healthcare decisions. Find out how you will be affected by the law at www.chcf.org

To help Californians gain a better understanding of ACA, the California Healthcare Foundation developed a guide, “The Affordable Care Act: What Californians Should Know,” For more information, visit the California Healthcare Foundation at www.chcf.org.

Medical Board of California (MBC)
The Medical Board of California is a state regulatory agency charged to protect health care consumers through the proper licensing and regulation of physicians and surgeons and certain allied health care professions and through the vigorous, objective enforcement of the Medical Practice Act, and, to promote access to quality medical care through the Board's licensing and regulatory functions.

The Medical Board of California is the only authority in the state that may take disciplinary action against the license of the physician(s) to whom your complaint relates. Visit their website at www.mbc.gov or call 1-800-633-2322 toll free. The MBC is located at 2005 Evergreen Street, Suite 1200, Sacramento, CA 95815.

Medical Records, Patient Access
Patients are legally entitled to copies of their medical records for a reasonable fee. To request copies of your medical records, contact your physician directly. Click here for more information from the Medical Board of California. Click here for more information.

Medi-Cal: Find a Physician Who Accepts Medi-Cal

Medicare: Health Insurance Counseling & Advocacy Program (HICAP)
HICAP offers free, one-on-one Medicare counseling. Trained volunteer counselors can answer your questions and help you understand your Medicare rights and benefits, how to appeal coverage denials, Medicare supplemental insurance (Medigap policies), Medicare Advantage plans, employee and retiree coverage, and long-term care insurance. Legal help and representation at Medicare appeals or administrative hearings are also available. 1-800-434-0222 or visit http://www.cahealthadvocates.org/ for more information.

Patient Health Education
The California Medical Association Foundation provides patient educational materials on a wide variety of health issues, including diabetes, obesity, pediatric vaccines, flu and cold, and the proper the use of antibiotics. For more information, visit www.thecmafoundation.org

Dispute Resolution

As a patient and a consumer, there may be times when you’re dissatisfied with the care you are receiving – whether by a personal physician, hospital, or your insurer. Some problems can be resolved informally simply by talking to the parties involved, but others will require that you follow an official set of "grievance procedures.” It’s important to try and resolve a problem, particularly when it affects your health. Depending on the issue, there are many independent organizations that can assist in difficult situations.

Physician Disputes

If you are unhappy with something your doctor has said or done, it's important that you speak to him or her about it as soon as possible, especially if it concerns your health. Often, a frank conversation is enough to solve the problem.

The North Bay County Medical Societies may be able to assist in mediating disputes between patients and individual physicians. If you are experiencing difficulties with a physician, for Sonoma, Marin and Mendocino-Lake call (707) 525-4375 and for Napa & Solano call (707) 255-3622. A complaint form must be completed and your signature is required for release of medical information pertinent to your complaint. The physician will be notified of your complaint. If needed, our Professional Conduct & Ethics Committee will review your complaint and inform you of its recommendations.

Please note: This is a confidential, peer-review advisory process; disciplinary action can only be taken by the Medical Board of California (MBC). To file a complaint with the MBC, call (800) 633-2322 or visit www.medbd.ca.gov.

Patient Complaints with Hospital and Inpatient Facilities

If you're having a problem with a hospital or other health care facility, the first step is to contact their "patient complaint coordinator." If you do not get a satisfactory response and would like to take further action, the government agency responsible for licensing and regulating hospitals is the California Department of Public Health (CDPH). To file a complaint with CDPH, fill out the online consumer complaint form. If your complaint involves a facility in El Dorado, Placer, Sacramento or Yolo counties, you may also contact the CDPH Licensing and Certification District Office at (800) 554-0354.

Patient Complaints with Health Plans

If you have a problem with your health plan, you have the right to file a complaint. A complaint is also called a grievance or an appeal. The rules and procedures for filing a complaint will vary based on the type of plan. Contact your health plan for information on accessing the plan’s formal dispute process. If you then do not get resolution, and depending on what type of health insurance you have, there are two state agencies with which you can file a complaint against your health plan:

The Department of Managed Health Care (DMHC) regulates all HMOs, plus Blue Shield of California PPO and Anthem Blue Cross of California PPO. These plans are subject to regulation under the Knox-Keene Act. To file a complaint, contact DMHC’s Help Center at (888) HMO-2219, TDD (877) 688-9891 or visit the DMHC website.

You can also contact DMHC by mail at:

Department of Managed Health Care
Help Center
980 9th Street, Suite 500
Sacramento, CA 95814-2725

Patient Complaints with Health Insurers

PPOs (except Blue Cross and Blue Shield PPOs) and other non-HMO insurers are regulated by the Department of Insurance (DOI). DOI investigates complaints, prosecutes insurers when appropriate and responds to complaints and inquiries by members of the public concerning the handling of insurance claims or alleged misconduct by insurers.

If you have a complaint about a health insurer, the first step is to contact the insurance company in an effort to resolve the issue. If you need help with a grievance involving an emergency or that has not been satisfactorily resolved by your insurer, you may contact DOI for assistance at (800) 927-HELP (4357), TDD (800) 482-4833 or by completing an online complaint form.

You can also contact DOI by mail at:

California Department of Insurance
Consumer Communications Bureau
300 South Spring Street, South Tower
Los Angeles, CA 90013

Medicare Patient Grievances

Medicare patients are entitled to special grievance and appeal rights. Medicare HMOs, competitive medical plans, and health care prepayment plans are required by law to give you a complete written explanation of your grievance and appeal rights. The Medicare website, www.medicare.gov, is also helpful. Information on appeals can be found at www.medicare.gov/basics/appeals.asp.

HICAP (the Health Insurance Counseling & Advocacy Program) provides free and objective information and counseling about Medicare. Volunteer counselors can help you understand your specific rights and health care options. Contact HICAP at 1-800-434-0222 or www.cahealthadvocates.org/HICAP.

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