Rights and Responsibilities


 

As a member of an HMO, you have rights and responsibilities. 

Member responsibilities: view PDF

Member rights: 

 

Each member has the right to:

  • Exercise your rights without discrimination.

  • Be provided with comprehensive information about the medical group, its services, providers, their qualifications, and the health care service delivery process.

  • Be informed of emergency and non-emergency coverage and cost of care, and receive an explanation of financial obligations as appropriate prior to incurring the expense (co-payments, deductible, and co-insurance).

  • Be provided information on how to obtain care after normal business hours and how to obtain emergency care including when to access emergency care or use 911.

  • Be informed of the name and qualifications of a Primary Care Physician or other specialist physicians coordinating your care.

  • Have 24-hour access to your Primary Care Physician (or their covering physician).

  • Receive complete information about the diagnosis, proposed course of treatment or procedure, alternate courses of treatment and non-treatment, the clinical risks involved in each, and prospects for recovery in terms that are understandable, in order to give informed consent or to refuse that course of treatment.

  • Candidly discuss appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage.

  • Actively be involved with doctors and other health care professionals in making decisions regarding your health care.

  • Be treated with courtesy, respect and dignity; receive considerate and respectful care with full consideration of privacy.

  • Be afforded the opportunity to consent or deny the release of identifiable medical or other information except when such release is required by law.

  • Express opinions or concerns to the medical group about the care provided (contact Member Services).

  • Be informed of the member complaint/grievance and appeal process, as well as the ability to express a complaint in writing or by phone.

  • Be informed of the availability of physicians, termination of a physician, or practice site. Receive assistance in selecting a new Primary Care or Specialty Physician.

  • Change your Primary Care Physician by contacting your health plan.

  • Receive reasonable continuity and continuation of care and be given timely and sensible answers to questions and requests made for service, care, covered benefits, non-covered services and payment.

  • Be informed of continuing health care requirements following office visits, treatments, procedures, and hospitalization.

  • Be represented by parents, guardians, family members or other conservators when you are unable to fully participate in your treatment decisions.

  • Be informed and make recommendations to the Member Rights and Responsibilities.


Location
Physicians Medical Group of San Jose
2304 Zanker Road
San Jose, CA 95131
Phone: 408-937-3600
Fax: 408-937-3634
Office Hours

Get in touch

408-937-3600