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HPSM Member Rights and Responsibilities

As a member of HPSM, you have certain rights and responsibilities that are established by the Centers for Medicare and Medicaid Services (CMS), the Department of Health Care Services (DHCS), and HPSM policies and procedures.

HPSM members have these rights:

  • To be treated with respect and recognition of your 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 plan, its services, practitioners, and providers, including Covered Services and member’s rights and responsibilities.
  • To be able to choose a primary care provider within HPSM’s network (unless you have primary other health coverage).
  • To participate in decision making with your providers about your own health care, including the right to refuse treatment.
  • To voice complaints, either verbally or in writing, about the organization or the care received.
  • To receive care coordination.
  • To request an appeal of decisions to deny, defer or limit services or benefits.
  • To receive oral interpretation services for your language.
  • To receive free legal help at your local legal aid office or other groups.
  • To formulate advance directives.
  • To request a State Hearing, including information on the circumstances under which an expedited hearing is possible.
  • To access Minor Consent Services.
  • To receive written member-informing materials in alternative formats (such as braille, large-size print, and audio format) upon request and in a timely fashion appropriate for the format being requested and in accordance with Welfare & Institutions 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 receive information on available treatment options and alternatives, regardless of cost or benefit coverage, presented in a manner appropriate to your condition and ability to understand.
  • To have access to and receive a copy of your medical records, and request that they be amended or corrected, as specified in 45 Code of Federal Regulations §164.524 and 164.526.
  • Freedom to exercise these rights without adversely affecting how you are treated by HPSM, your providers or the State.
  • To have access to family planning services, Freestanding Birth Centers, Federally Qualified Health Centers, Indian Health Service Facilities, midwifery services, Rural Health Centers, sexually transmitted disease services and Emergency Services outside HPSM’s network pursuant to the federal law.
  • To make recommendations about HPSM’s member rights and responsibilities.

HPSM members have these responsibilities:

  • Carefully read all HPSM Member materials so that you understand how to use your benefits and what procedures to follow when you need care.
  • Do your best to keep provider appointments; if you need to cancel or reschedule an appointment, call your provider at least 24 hours in advance or as soon as possible.
  • Show your HPSM ID card or remember to tell your Provider (your doctor, hospital, or pharmacy) that you are an HPSM member before receiving care.
  • Follow the treatment plan that you and your provider have agreed upon.
  • Provide accurate and complete information about your health care needs to HPSM and to your provider. Tell your provider if you have a medical condition.
  • As best as you can, understand your health care needs and participate in developing treatment plans and goals with your providers.
  • Follow the plans and instructions for care that you have agreed upon with your provider. Ask your provider questions if you do not understand something or are not sure about the advice that you are given.
  • See the Specialists to whom your Primary Care Provider (PCP) refers you.
  • Actively participate in health care programs that keep you well.
  • Work with your providers to build and maintain a good working relationship.
  • Use the emergency room only in case of an emergency or as directed by your provider.
  • Follow-up with your Primary Care Provider (PCP) after getting care at an emergency facility.
  • Report lost or stolen ID cards to HPSM Customer Support and do not let anyone else use your HPSM ID card.
  • Call HPSM Customer Support if you do not understand how to use your benefits or have any problems with the services that you received.
  • Tell HPSM if you move and/or change your phone number. Call HPSM Customer Support and the San Mateo County Human Services Agency. If you receive SSI, call Social Security Administration. We all need to have your correct address and phone number on file.
  • Follow the HPSM Grievance procedure if you want to file a complaint.
  • Treat all HPSM staff and your health care providers respectfully and courteously.