MEMBER'S RIGHTS AND RESPONSIBILITIES
As a member of Blue Shield of California Promise Health Plan you have important rights and responsibilities.
You have the right to know:
- Your rights and responsibilities
- About our organization, services, doctors, and specialists
- When your doctor is no longer contracted with Blue Shield of California Promise Health Plan
- About all of our other caregivers
- About your medical records and the State and Federal laws that apply to their access and use
- About all treatment choices for your condition, regardless of cost or benefit coverage
You have the right to:
- Always be treated with respect and dignity
- Have your privacy kept safe by everyone in our health plan
- Know that we keep all your information private
- Be in charge of your health care
- Choose your primary care doctor
- Say no to care from your primary care doctor or other caregivers
- Make choices about your health care
- Make a living will. This is also called an advance directive.
- Voice complaints or appeals about Blue Shield of California Promise Health Plan or the care it offers
- File a grievance if you do not receive services in the language you request
You have the right to receive the following range of services:
- Family planning services
- Preventive health care services
- Minor consent services
- Treatment for sexually transmitted diseases (STDs)
- Emergency care outside of our network
- Health care from a Federally Qualified Health Center (FQHC)
- Health care at an American Indian Health Center
- A second opinion
- Interpreter services at no cost. This includes services for the hearing-impaired.
- Receive information materials in other formats. For example, you can request large size print upon request
You have the right to suggest changes to our health plan:
- Tell us what you do not like about our health plan
- Tell us what you do not like about the health care you receive
- Question our decisions about your health care
- Tell us what you do not like about our rights and responsibilities policy
- Ask the Department of Social Services for a fair hearing
- Ask the Department of Managed Health Care for an Independent Medical Review
- Choose to leave our health plan
You have the right to end your Blue Shield of California Promise Health Plan membership (disenroll):
Ending your membership in Blue Shield of California Promise Health Plan may be voluntary (your own choice) or involuntary (not your own choice). For more information on ending your membership, please refer to the Member Handbook.
We hope you will work with your doctors as partners in your health care.
You have important responsibilities for your healthcare.
- Make an appointment with your doctor for a very important health exam within 90 days of becoming a new member. This appointment is called an Initial Health Assessment.
- Tell your doctor what he or she needs to know about your health issues.
- Learn as much as you can about your health, and work with your doctors to agree on treatment goals.
- Follow the treatment plans you and your doctors have decided to follow.
- Follow what the doctor tells you to do to take good care of yourself.
- Engage in habits and practices that help to keep you from getting sick.
- Bring your ID card with you when you visit your doctor.
- Treat your doctors and other caregivers with respect.
- Use the emergency room for emergencies only. Your doctor will give you most of the medical care that you need.
- Report healthcare fraud.
We want you to understand your health plan.
- Know and follow the rules of your health plan.
- Know that laws guide our health plan and the services you receive.
- Know that we cannot treat you differently because of age, sex, race, national origin, culture, language needs, sexual orientation and/or health status.
Advance Directives right notification
At enrollment, you have the right to accept or refuse treatment, and to complete an advance directive. We will assist you in completing the advance directive.
To file a complaint with the state agency that surveys and certifies Medicare and Medicaid providers, go to the appeals and grievances page.
Get more information on Advance Directives:
California Advance Health Care Directive, English (PDF, 824 KB)
California Advance Health Care Directive, Spanish (PDF, 1 MB)
California Advance Health Care Directive, Chinese (PDF, 5.4 MB)
California Advance Health Care Directive, Bilingual English/Spanish (PDF, 2 MB)
California Advance Health Care Directive, Bilingual English/Vietnamese (PDF, 2.4 MB)
Frequently asked questions
See questions our members ask most frequently about Blue Shield Promise Medi-Cal.
Appeals and grievances
Learn how to file a complaint, grievance, or an appeal.
Get the Member Handbook (Evidence of Coverage, EOC) and other important documents for your area.
Learn about plan benefits and programs.