Our
Quality Makes
a Real Difference
Everyone is concerned about quality care and service, especially our patients. We are committed to seeing that our patients receive the quality health care they deserve and expect. So we designed our Quality and Utilization Management Program to build our patients' confidence that they are getting the care they need from people who care about them. This is how our Quality and Utilization Management Program ensures that we deliver safe, effective, quality health care and services:
We honor our patients' rights. All
of our patients
are entitled to be
treated in a manner
that respects their
rights. We recognize
the specific needs
of our patients and
maintain a mutually
respectful relationship
with them. This is
our commitment to the
rights of our patients
. . . and to those
other than the patient
who are legally responsible
for making health care
decisions for
the patient.
As a Valley Care IPA patient, you
have the right to:
Receive health care services
regardless of your;
| race
.
.
. |
claims
experience
. . . |
| ethnicity
.
. . |
medical
history
. . . |
| national
origin
. . . |
evidence
of
insurability...
(including
conditions
arising
out
of
acts
of
domestic
violence) |
| religion
.
. . |
| sex
.
.
. |
| age
.
.
. |
source
of
payment... |
| mental
or
physical
disability.. |
genetic
information
. . . |
| medical
conditions
. . . |
sexual
orientation
. . . |
- Receive information about
Valley Care IPA and
its services . . .
doctors . . . health
care professionals
and providers . . .
and patients’ rights
and responsibilities,
as well as information
about your health plan’s
coverage for services
you may need or are
considering.
- Be
treated with respect
and recognition of
your dignity and right
to privacy.
- Be represented by parents,
guardians, family members
or other conservators
if you are unable to
fully participate in
treatment decisions.
- Have information about
our contracting physician
and provider payments
agreements, as well
as explanations for
any bills you receive
for services not covered
by SVIPA or your health
plan.
- Receive health care
services without
requiring you to
sign an authorization,
release, consent or
waiver that would permit
us to disclose your
medical information. We
will treat information
about you, including
information about
services and treatment
we provide, as confidential
according to all current
privacy and confidentiality
laws.
- Have round-the-clock
access, seven days
a week, to your primary
care physician or an
on-call physician when
your primary care physician
is unavailable.
- Know the name and qualifications
of the physician who
has primary responsibility
for coordinating your
care . . . and
the names, qualifications,
and specialties of
other physicians, and
non-physicians who
are involved your care.
- Have a candid discussion
of medically appropriate
or necessary treatment
options for your condition — regardless
of the cost — the
extent of benefit coverage
or the lack of benefit
coverage. To the extent
permitted by law, this
includes the right
to refuse any procedure
or treatment. If you
refuse a recommended
procedure or treatment,
we will explain the
effect that may have
your health.
- Actively participate
in decisions regarding
your health care and
treatment plan and
receive services at
your own expense if
we deny coverage. The
decision to receive
a particular service
or treatment rests
with you and your treating
physician or health
care professional.
- Receive complete
information — before
receiving care
and in terms you
can understand— about
an illness, proposed
course of treatment
or procedure, and
prospects for recovery,
so that you may
be well informed
when consenting
to refusing a course
of treatment. This
includes being able
to request and receive
information about
how medical treatment
decisions are made
by physicians, health
care professionals
or providers and
Valley Care IPA,
and the criteria
or guidelines applied
when making such
decisions, and an
explanation of the
cost of the care
you will receive
and what you will
be expected to pay
out of your own
pocket.
- Except in emergencies,
this information will
include a description
of the procedure or
treatment . . . the
medically significant
risks involved . .
. any alternate course
of treatment or non-treatment
and the risks involved
in each . . . and the
name of the person
who will carry out
the procedure or treatment.
- Receive information
about your
medications — what
they are, how
to take them, and possible
side effects.
- Reasonable continuity
of care and to know
the time and location
of appointments . .
. the name of the physician
providing care .
. . and continuing
health care requirements
following discharge
from inpatient or outpatient
facilities.
- Be advised if a physician
proposes to engage
in experimental or
investigational procedures
affecting your health
care or treatment.
Patients have the right
to refuse to participate
in such research projects.
- Obtain upon request
a copy or summary of
the Utilization Management
Program Description
and the Quality Improvement
Program Description
that Valley Care IPA
publishes annually.
- Voice complaints about
us or appeal our care
decisions.
-
Be informed of rules
regarding patient conduct
in any of the various
settings where you
receive health care
services as our patient.
- Complete an advance
directive, living will
or other instructions
concerning your care
in the event that in
the future you become
unable to make those
decisions while receiving
care through our physicians,
health care professionals
and providers.
- Make recommendations
about these patients’ rights
and responsibilities
policies.
Our
patients share
responsibility
for their care. In
keeping with honoring
our patients’ rights,
we have expectations
of our patients. You
have a responsibility
to:
- Be familiar with the
benefits, limitations
and exclusions of your
health plan coverage.
- Supply your health care
provider with complete
and accurate information
which is necessary
for your care (to the
extent possible).
- Be familiar and comply
with our rules for
receiving routine,
urgent, and emergency
care.
- Contact your primary
care physician (or
covering physician)
for any care that you
may needed after that
physician’s
normal office hours,
including on weekends
and holidays.
- Be on time for all appointments
and notify the physician’s
or other provider’s
office as far in advance
as possible for appointment
cancellation or rescheduling.
- Obtain an authorized
referral form from
your primary care physician
before making an appointment
with a specialist and/or
receive any specialty
care.
Understand your health
problems . . . participate
in developing mutually
agreed upon treatment
goals to the degree
possible . . . and
inform your physicians
and health care providers
if you do not understand
the information they
give you.
- Follow treatment plans
and instructions for
care you have agreed
on with your physicians
and health care professionals,
and report changes
in your condition.
- Accept your share of
financial responsibility
for services received
while under the care
of a physician or while
a patient at a facility.
- Treat your physicians
and health care providers
and their office staff
with respect.
- Contact our Managed
Care Call Center or
your health plan’s
Member Services Department
if you have questions
or need assistance.
- Respect the rights,
property and environment
of your physicians
and health care providers,
their staff and other
Valley Care IPA patients.
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