Call Your HMO Member Services First

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If you have a problem, call your HMO's Member Services. You may be able to solve your problem with a phone call.

There are groups that can help you if you have a problem with your HMO. Call the Legal Aid Society of San Diego.
If you have Medicare, you can get help from HICAP.
If you have Medi-Cal, call Medi-Cal Managed Care Ombudsman.

You Have The Right To:

Be treated with courtesy and respect.
Get quality health care in a timely manner.
Get an appointment when you need one.
Get care from qualified medical personnel.
Choose a doctor you trust.
Understand your condition and the risks and benefits of different treatments.
Get a second opinion.
Choose or refuse treatment.

HICAP (Health Insurance Counseling & Advocacy Program)
Information, counseling and advocacy for Medicare members
(800) 434-0222

HMO Help Center
Information and help for California HMO members
(888) HMO-2219 www.hmohelp.ca.gov

Medi-Cal Managed Care Ombudsman
Help with a problem you can't solve with your Medi-Cal HMO
(888) 452-8609

Office of the Patient Advocate
Information on California HMOs
(866) 466-8900 www.opa.ca.gov

HMO Help Center Information and help for California HMO members (888) HMO-2219 www.hmohelp.ca.gov

Take notes when you have a phone call or meeting.
Get the name of the person you talk to.
Have someone with you for extra support.
If you are denied care, ask for the reason in writing.
If the person you talk to isn't helpful, ask to speak to a supervisor.
If different people tell you different things about the services you can get, ask to speak to a supervisor.
Be persistent. It may take many calls to get the services you need.

What Happens After You File a Complaint
You will usually get a letter from the HMO Help Center that explains the decision. You should get it within 30 days, or sooner if your problem is urgent.

If the complaint is decided in your favor, your HMO must comply.

If You Need Help Right Away
If your problem involves a serious or immediate threat to your health, such as denial of treatment for a life-threatening disease, call the HMO Help Center. Say that your problem is urgent.