Exercise these rights without regard to gender, sexual orientation or cultural, economic, educational or religious background.
Be provided with comprehensible information about our medical group, services, providers and the healthcare service delivery process. This information includes instructions about how to obtain care with various providers and at varied facilities (e.g., primary care, specialty care, behavioral health services, and hospital services). Additionally, information will be included about how to obtain services outside the IPA system or service area.
Be informed of emergent and non-emergent benefit coverage and 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).
Be provided with instructions in accordance with prudent layperson standards and address the needs of non-English speaking members with information about how to obtain care after normal office hours and how to obtain emergency care including when to directly access emergency care or use 911 services.
Receive and examine an explanation of bills generated for services delivered to the member.
Be provided with information on how to submit a claim for covered services.
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, 7 days a week 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, to give informed consent or to refuse that course of treatment.
Candidly discuss appropriate or medically necessary treatment options for the member’s condition, regardless of cost or benefit coverage.
Actively participate in decisions regarding the member’s healthcare and treatment 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 member information and records used for any purpose.
Be informed of applicable rules in the various health care settings regarding member conduct.
Express opinions or concerns about our medical group or the care provided and offer recommendations for change in the healthcare service delivery process by contacting the Member Services Department.
Be informed of the member complaint/grievance and appeal process including how to express a complaint or appeal.
Be informed of the termination of a primary care provider or practice site and receive assistance in selecting a new primary care provider or site in this situation.
Change primary care physicians by contacting the Member Services Department at your health plan.
Be provided information on how we evaluate with health plans, new technology for inclusion as a covered benefit.
Receive reasonable continuity of care and be given timely and sensible responses to questions and requests made for service, care and payment (including complaints and appeals).
Be informed of continuing healthcare requirements following office visits, treatments, procedures and hospitalizations.
Have all member rights apply to the person who has the legal responsibility to make healthcare decisions for the member.
To make available and or assist Limited English Proficiency (LEP) members access to their contracted health plan interpreter services or when requested at any scheduled or unscheduled or unscheduled visits at provider offices, including ancillary providers, specialty service providers, diagnostic testing facilities, and urgent care at no cost to the member.
Right to make recommendations regarding member rights and responsibilities policies.
Request enrollment in, or to decline or disenroll from, case management and/or disease management programs.
For any member denial the member will be able to contact the Medical Group and request a copy of the criteria used to make the decision on a denial that the group has made.
Member Responsibilities Policy
The member has the responsibility to:
Be familiar with the benefits and exclusions of the member’s health plan coverage.
Provide the member’s healthcare provider with complete and accurate information 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.
Report changes in the member’s condition according to provider instructions.
Inform providers of the member’s inability to understand the information given to him/her.
Carry out the treatment plan that has been developed and agreed upon by the healthcare provider and the member.
Contact the member’s primary care physician (or covering physician) for any care needed after that physician’s normal office hours.
Treat the healthcare provider and staff with respect.
Obtain an authorized referral from the member’s primary care physician for a visit to a specialist and/or to receive specialty care.
Be familiar and comply with our healthcare service delivery system regarding access to routine, urgent and emergent care.
Contact the Member Services Department or the member’s health plan Member Services Department regarding questions and assistance.
Respect the rights, property and environment of all physician and medical group providers, staff and other members.
Have all of these responsibilities apply to the person who has the legal responsibility to make healthcare decisions for the member.
Make recommendations regarding our member rights and responsibilities.
Some important notes for our members and providers:
We and our affiliates do not reward or offer incentives to employees or associates to encourage inappropriate under-utilization of services. We are committed to providing quality care to our members, and therefore:
Utilization Management decision-making is based only on appropriateness of care and service and existence of coverage.
We do not specifically reward practitioners or other individuals for issuing denials of coverage or service care.
Financial incentives for utilization management decision makers do not encourage decisions that result in underutilization.
For any questions regarding the Utilization Management decision making or other issues related to the Utilization Management process, please call toll-free (866) 654-3471.
Language Assistance/Interpreter Services
In accordance with California Assembly Bill 853, all of our medical group providers will provide, at no cost to the member, Language Assistance/Interpreter Services for those who are limited in English proficiency. Ask your primary care physician for assistance if you need help with interpreter services.
The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule affords members the right to receive a notice that describes how health information may be used and disclosed and how to get access to this information. ADOC Medical Group (ADOC) is required to send a notice ("Notice of Privacy Practices") to members of our insured Health and Long Term Care plans.
ADOC welcomes you to their website. All information that is collected on our website is done on a voluntary basis. All non-public personal information that you provide via our website will be used strictly for the purpose stated on the page where it is collected. ADOC will not sell, license, transmit or disclose this information outside of ADOC or our affiliated companies unless (1) required or permitted by law, (2) expressly authorized by you, or (3) necessary to enable ADOC contractors or agents to perform certain functions for us. With all disclosures, we will disclose information consistent with applicable law and regulations and we will require the recipient to protect the information and use it only for the intended purpose.
"Personal Information" is defined as data that is unique to an individual, for example: name, address, member id, date of birth, or telephone number. There may be occasions where we may request personal information on our website in order to provide services or respond to your questions.
Feedback and questions are always welcome on our website. We have provided e-mail boxes for that purpose. Your feedback and questions will be shared with our customer service representatives and those employees most capable of addressing your feedback and questions.
Please note e-mail, like most, if not all, non-encrypted Internet e-mail communications, may be accessed and viewed by other Internet users, without your knowledge and permission, while in transit to us. For that reason, to protect your privacy, please do not use e-mail to communicate information to us that you consider confidential. If you wish, you may contact us instead via non-cellular telephone at the numbers provided on our Contact Us page or Member Services at 866-654-3471.
We have made some locations on our website secure, so you can exchange non-public personal information with us. You will be provided appropriate instructions at each of these locations.
Linking to Other Sites
ADOC's website may provide links to other websites, that are not owned or maintained by ADOC, that we think might be useful or of interest to you. These other websites will open in a separate browser window. We are not responsible for the privacy practices used by other websites, the content, or accuracy of the other websites. These links to other non-ADOC websites do not constitute or imply endorsement by ADOC of these websites, any products or services described on these sites, or of any material contained in them.
ADOC has adopted and adheres to stringent security standards designed to protect non-public personal information at www.adoc.us against accidental or unauthorized access or disclosure. Among the safeguards that ADOC has developed for this site are administrative, physical and technical barriers that together form a protective firewall around the information stored at this site. We periodically subject our site to simulated intrusion tests and have developed comprehensive disaster recovery plans.
Changes to this Statement
ADOC may change this Statement from time to time without notice. This Statement is not intended to and does not create any contractual or other legal rights in or on behalf of any party.
All information provided on this web is "AS IS" without warranty of any kind, either express or implied warranties of merchantability, fitness for a particular purpose, or non-infringement. Some jurisdictions do not allow for the exclusion of implied warranties, so the exclusion above may not apply to you. The data set forth herein is for informational purposes only, and no warranty is made that the information is error-free. Please note that once you leave this site, either by using a link we may have provided for your convenience or by specifying your own destination, ADOC accepts no responsibility for the content, products and/or service provided at these non-ADOC locations. ADOC does not control, endorse, promote, or have any affiliation with any other website unless expressly stated herein.
ADOC will not be held liable to any party for any direct, indirect, special, or other consequential damages arising from any use of this website, or any linked website, including, without limitation, any loss of profits, business interruption, loss of programs or data on your equipment, or otherwise, even if we are expressly advised of the possibility or likelihood of such damages.
Changes to This Website
Information may be changed or updated without notice. ADOC has no obligation to update information presented on this website, so information contained herein may be out of date at any given point in time. ADOC may also make improvements and/or changes in the services and/or programs described in this information at any time without notice.