Questions about this exciting change? Please read our press release for more information.
Our Quality Makes a Real Difference
We are committed to seeing that our members receive the quality healthcare they deserve and expect. Our Quality and Utilization Management Programs was developed to ensure that we deliver safe, effective and quality healthcare services.
This is how we ensure that we deliver safe, effective, quality healthcare and services:
We Honor Our Member's Rights
All of our members are entitled to be treated in a manner that respects their rights. We recognize the specific needs of our members and maintain a mutually respectful relationship with them. This is our commitment to the rights of our members . . . and to those other than the member who are legally responsible for making healthcare decisions for the member.
As our member, you have the right to:
- Receive healthcare services regardless of your race, ethnicity, national origin, religion, sex, age, mental or physical disability or medical conditions, sexual orientation, claims experience, medical history, evidence of insurability (including conditions arising out of acts of domestic violence), genetic information, or source of payment.
- Receive information about us and our services, doctors, healthcare professionals and providers, members’ 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 us or your health plan.
- Receive healthcare 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 PCP or an on‐call physician when your PCP is unavailable.
- Know the name and qualifications of the doctor who is mainly responsible for coordinating your care . . . and the names, qualifications, and specialties of other doctors, and other providers who are involved in your care.
- Have a candid discussion of medically appropriate or necessary treatment options for your condition — regardless of the cost, the extent of your benefits or the lack of coverage. To the extent permitted by law, this includes the right to refuse any procedure or treatment.
- Actively participate in decisions regarding your healthcare and treatment plan and receive services at your own expense if we deny coverage. You and your treating doctor or healthcare provider decide whether you will receive a particular service or treatment.
- 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 refuse a course of treatment. This includes:
- being able to request and receive information about how medical treatment decisions are made by our review staff, 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 recommended 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 recommended 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 healthcare requirements following discharge from inpatient or outpatient facilities.
- Be advised if a doctor proposes to engage in experimental or investigational procedures affecting your healthcare or treatment. Members 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 Management Program Description that we publish annually.
- Voice complaints about us or appeal our care decisions.
- Be informed of rules about member conduct in any of the various settings where you receive healthcare services as our member.
- 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, healthcare professionals and providers.
- Make recommendations about these members’ rights and responsibilities policies.
Our Members Share Responsibility for their Care
Just as we honor our members’ rights, we have expectations of our members. You have a responsibility to:
- Be familiar with the benefits, limitations and exclusions of your health plan coverage.
- Supply your healthcare 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 PCP (or covering doctor) for any non‐urgent or emergency care that you may need after the doctor’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 PCP before making an appointment with a specialist and/or receiving any specialty care.
- Understand your health problems . . . participate in developing mutually agreed upon treatment goals to the degree possible . . . and inform your doctors and healthcare providers if you do not understand the information they give you.
- Follow treatment plans and instructions for care you have agreed on with your doctors and healthcare providers, 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 doctors and healthcare providers and their office staff with respect.
- Contact our Customer Services Department or your health plan’s member services if you have questions or need assistance.
- Respect the rights, property and environment of your physicians and healthcare providers, their staff and other patients.
We carefully observe all of the laws, regulations and professional ethics that govern member privacy and the confidentiality of member information. We do not give out any information that makes it possible to anyone or any organization to individually identify any of our members. View our HIPAA information or our Website Privacy information.
Our grievance and appeals process gives our members a way to resolve concerns with the medical care and services we provide. We work closely with our members’ health plans and follow their rules for handling the issue. Whether the problem concerns access to care, dissatisfaction with our doctors or employees or a decision we made about medical services, we will investigate the issue and work toward a satisfactory solution.
If you have a problem that needs to be brought to our attention or disagree with a decision we made about a service request, you must first contact your health plan. You can file your complaint over the phone by calling the number printed on your health plan ID card. Please refer to your health plan member information materials for more detailed instructions on how to file a complaint/grievance or service denial appeal.
In addition to your health plan’s grievance and appeal process, you may also contact the California Department of Managed Health Care (DMHC). The DMHC regulates healthcare service plans. Before contacting the DMHC, you should first phone your health plan and use their grievance process. The DMHC has a toll‐free telephone number (1‐800‐400‐0815) to receive complaints regarding health plans. The hearing and speech impaired may use the California Relay Service’s toll‐free numbers (800) 735‐2929 (TTY) or (888) 877‐5378 (TTY) to contact the DMHC. The Department’s Internet web site (http://www.hmohelp.ca.gov) has complaint forms and instructions online.
If you need more information about your health plan or DMHC complaint/grievance or appeal process, call our Customer Services Department at the number listed in the Call Us For Help section.
If you have not already done so, you should think about completing an Advance Health Care Directive. Also known as a Durable Power of Attorney for Health Care, an Advance Health Care Directive can help ensure that your wishes concerning your medical care are followed if you are unable to make your own healthcare decisions. You can designate a person to be your “agent” in making some or all healthcare decisions for you at any time that you may not be able to make such decisions for yourself. Your agent can be anyone over age 18, except your physician or his/her employees.
Under California law, all adults of sound mind have the right to make their own decisions with regard to accepting or refusing medical treatment or life‐sustaining procedures. The multi‐part Advance Health Care Directive is a legal document through which you can communicate your wishes about the care and treatment you want—or don’t want— if you reach a point where you are no longer able to make or articulate your own healthcare decisions. You may want to discuss these decisions with your physician and family members.
Talk to your PCP about setting up an Advance Health Care Directive. They make very good legal sense for anyone over 18 years of age. You can review and download the Advance Directive from our website www.dignityhealth.org/ventura.
We comply with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, sex, age, sexual orientation, disability or method of payment. We do not exclude people or treat them differently because of race, color, national origin, sex, age, sexual orientation, disability or method of payment.
We provide appropriate auxiliary aids and services, free of charge and in a timely manner, to individuals with disabilities. For hearing impaired, please call TDD/TYY: 711.
Dignity Health Medical Network‐Ventura:
- Provides free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters
- Written information in other formats (large print, audio, accessible electronic formats, other formats)
- Provides free language services to people whose primary language is not English, such as: Qualified interpreters or Information written in other languages.
If you need these services, contact our Compliance Officer.
If you believe that Dignity Health Medical Network‐Ventura has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Compliance Officer, 751 E. Daily Drive,Suite 120, Camarillo, CA 93010, Phone: 877‐299‐5599, TDD/TYY: 711, Fax: 805‐256‐ 7840, mail to: PO Box 31840, Oxnard, CA 93031. You can file a grievance directly with your health plan by calling the number on the back of your health plan ID card.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at OCRPortal. hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1‐800‐368‐1019, 800‐ 537‐7697 (TDD). Complaint forms are available at HHS.gov/ocr/office/file/index.html.
We are committed to ensuring that our site is accessible to all users. We have attempted to implement features to improve the experience for individuals with disabilities. Some of these features are described below.
HTML text is formatted in a manner to allow website visitors to increase and decrease the text font size when using browsers that provide standard resizing functionality.
Images on the site contain 'ALT tags,' which aid users who listen to the content of the site with a screen reader.
Screen readers will interpret text links as hyperlinks rather than underlined text.
If you encounter any problems accessing this site, for help please call us at (844) 274-8497.
Dignity Health Medical Network‐Ventura provides language assistance services, free of charge and in a timely manner, to individuals with limited English proficiency. You can get an interpreter, documents read to you and some sent to you in your language. For help, please call the number listed on your ID card.