Patient rights

The physicians of Brown & Toland are dedicated to quality patient care. As a patient of a Brown & Toland physician, you will receive:

  • Courteous, considerate, and respectful treatment at all times.
  • Candid discussions of appropriate or medically necessary treatment options for your condition(s), regardless of cost or benefit options.
  • The right to accept or refuse medical or surgical treatment.
  • Access to preventive health care services and emergency care.
  • Information about benefits, where and how to seek care, and the risks involved in treatment.
  • Timely response to requests for services, inquiries, and complaints.
  • Second opinions when medically appropriate.
  • Titles and specialties of the health care professionals responsible for your care and the right to change to another doctor if you are not satisfied.
  • Continuity of care if your doctor leaves your plan and you meet certain conditions.
  • Health care services in a language you can understand and in a culturally sensitive way.
  • Privacy and confidentiality regarding your medical and health conditions.
  • The right to receive a copy of your medical records and to add your own notes to your records.
  • Information regarding the medical group and health plan grievance procedures.
  • The right to request an Independent Medical Review of a decision your health plan or medical group makes about your care.
  • Recognition of your rights to make decisions regarding your medical care, and to complete an Advanced Directive, thereby extending your rights to any person who may make decisions on your behalf regarding your medical care.
  • The right to make recommendations to your patient rights and responsibilities.

Patient responsibilities

As your health care partner, we ask that you:

  • Provide professional staff with all pertinent health care information needed to ensure the best possible medical outcome.
  • Communicate with your primary care physician (PCP) when you have questions or concerns about your health care.
  • Adhere to instructions and guidelines given for health care services.
  • Cooperate with health care professionals providing services to you, except in those instances when you have exercised your right to refuse service.
  • Assume responsibility for being aware of your health benefits and services and how to correctly obtain them.

If you have questions about your benefits, please call our Customer Service Department at 415-972-6002. You also may call your health plan’s member services department.

The California Department of Managed Health Care is responsible for regulating health care service plans. If you have a grievance against your health plan, you should first telephone your health plan and use your health plan’s grievance process before contacting the department. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health plan, or a grievance that has remained unresolved for more than 30 days, you may call the department for assistance. You may also be eligible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical services. The department also has a toll-free telephone number (1-888-HMO-2219) and a TDD line (1-877-688-9891) for the hearing and speech impaired. The department’s Internet Web site has complaint forms, IMR application forms and instructions online.

Affirmative Statement Regarding Utilization-Related Incentives

Brown & Toland Physicians health care professionals who make utilization management (UM) related decisions will be required to review and acknowledge receipt of the Affirmative Statement Regarding Utilization-Related Incentives (see below). At a minimum, the following associates must sign the Affirmative Statement annually:

  • Medical Directors
  • Medical Services Director and Managers
  • Licensed Medical Services Staff

Members may request, free of charge, a copy of the actual benefit provision, guideline, protocol, policy or other similar criterion on which a determination is based, by calling their health plan at the number listed on their ID card or Brown & Toland Customer Service at 415-972-6002.

Affirmation Statement Regarding Utilization-Related Incentives

All practitioners, providers and employees who make utilization management (UM) decisions affirm the following:

  • UM decision-making is based only on appropriateness of care and service and existence of coverage.
  • Brown & Toland does not specifically reward practitioners or other individuals for issuing denials of coverage.
  • Financial incentives for UM decision makers do not encourage decisions that result in underutilization.
  • Those making referral decisions are ensured independence and impartiality in that their decisions will not influence hiring, compensation, termination, promotion or any other similar matters.