Rights and Responsibilities

Your rights

These are your rights as a member of Health Net:

To be treated with respect and dignity, giving due consideration to your right to privacy and the need to maintain confidentiality of your medical information
To be provided with information about the health plan and its services, including covered services, practitioners, and member rights and responsibilities
To get fully translated written member information in your preferred language, including all grievance and appeals notices
To make recommendations about Health Net's member rights and responsibilities policy
To be able to choose a primary care provider within Health Net's network
To have timely access to network providers
To participate in decision making with providers regarding your own health care, including the right to refuse treatment
To voice grievances, either verbally or in writing, about the organization or the care you got
To know the medical reason for Health Net's decision to deny, delay, terminate or change a request for medical care.
To get care coordination
To ask for an appeal of decisions to deny, defer or limit services or benefits
To get no-cost interpreting and translation services for your language
To get free legal help at your local legal aid office or other groups
To formulate advance directives
To ask for a State Hearing if a service or benefit is denied and you have already filed an appeal with Health Net and are still not happy with the decision, or if you did not get a decision on your appeal after 30 days, including information on the circumstances under which an expedited hearing is possible
To disenroll (drop) from Health Net and change to another health plan in the county upon request
To access minor consent services
To get no-cost written member information in other formats (such as braille, large-size print, audio and accessible electronic formats) upon request and in a timely fashion appropriate for the format being requested and in accordance with Welfare and Institutions (W&I) Code section 14182 (b)(12)
To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation
To truthfully discuss information on available treatment options and alternatives, presented in a manner appropriate to your condition and ability to understand, regardless of cost or coverage
To have access to and get a copy of your medical records, and request that they be amended or corrected, as specified in 45 Code of Federal Regulations (CFR) sections 164.524 and 164.526
Freedom to exercise these rights without adversely affecting how you are treated by Health Net, your providers or the state
To have access to family planning services, Freestanding Birth Centers, Federally Qualified Health Centers, Indian Health Clinics, midwifery services, Rural Health Centers, sexually transmitted infection services and emergency services outside Health Net's network pursuant to the federal law
To request an Appeal of an adverse benefit determination within 60 calendar days from the date on the Notice of Adverse Benefit Determination (NABD) and request how to continue benefits during the in-plan appeal process through the State Fair Hearing, when applicable.

Your responsibilities

Health Net members have these responsibilities:

Act courteously and respectfully. You are responsible for treating your doctor and all providers and staff with courtesy and respect. You are responsible for being on time for your visits or calling your doctor's office at least 24 hours before the visit to cancel or reschedule.
Give up-to-date, accurate and complete information. You are responsible for giving correct information and as much information as you can to all of your providers, and to Health Net. You are responsible for getting regular check-ups and telling your doctor about health problems before they become serious.
Follow your doctor's advice and take part in your care. You are responsible for talking over your health care needs with your doctor, developing and agreeing on goals, doing your best to understand your health problems, and following the treatment plans and instructions you both agree on.
Use the Emergency Room only in an emergency. You are responsible for using the emergency room in cases of an emergency or as directed by your doctor. Emergency care is a service that you reasonably believe is necessary to stop or relieve sudden serious illnesses or symptoms, and injury or conditions requiring immediate diagnosis and treatment.
Report wrong-doing. You are responsible for reporting health care fraud or wrong-doing to Health Net Community Solutions. You can do this without giving your name by calling Health Net Fraud and Abuse Hotline toll-free at 1-866-685-8664. The Fraud Hotline operates 24 hours a day, seven days a week. All calls are strictly confidential.