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HMO Member Responsibilites

Ways to Get the Most From Your Membership

What are some of your responsibilities as an HMO member:

  • Know what your plan covers, and what it doesn’t cover. (To get a copy of, or ask questions about the EOC – Evidence of Coverage, call your HMO).
  • Know how to make an appointment, get medications, tests etc.
  • Establish a partnership with your doctor. If you have a good working relationship with your provider, you may hit fewer walls when trying to obtain services.
    This includes:

    • Prepare for appointments by having a list of issues, concerns and questions for your doctor.
    • Give your provider complete information regarding all medications/otc/substances, etc. used, as well as anything you are experiencing that is out of the ordinary
    • Be concise, but thorough, when speaking with your doctor. This demonstrates a respect for your provider’s time, while asserting your right for information. Although appointment slots are not usually very lengthy, most providers are more than willing to take the time, when they work with patients who want to actively participate in their care.
    • Ask questions if you are not clear about your health problem or treatment/management plans.
    • Take notes
    • Ask how to reach your doctor between visits
    • Ask for copies of your labs, reports, etc.
  • Keep records of your health care in one place, including test results, treatments, providers seen, etc.

If you belong to a Medi-Cal (SF Health Plan or Blue Cross) or Medicare HMO, you have the same rights and responsibilities. You may find that with a Medicare HMO you have fewer out of pocket expenses than traditional Medicare services. However, it is important to remember that a the Medicare HMO will also limit your options to a specific network of providers, and requires referrals that may or may not be as easily obtained as with traditional Medicare.

How Can ILRCSF help you? Help you to understand what is included in your coverage, and how to utilize services.