Member Rights

1. Privacy

• Be treated with respect and with due consideration for their dignity and privacy
• Expect that we will treat their records, including medical and personal information and communications, confidentially
• Request and receive a copy of their medical records at no cost to the member, and request that the records be amended or corrected
• Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation as specified in federal regulations

1. Take part in decisions regarding their health care

• Receive information on available treatment options and alternatives, presented in a manner appropriate to the member’s condition and ability to understand
• Engage in candid discussions of appropriate or medically necessary treatment options for their conditions regardless of cost or benefit coverage
• Receive the appropriate services that are not denied or reduced solely because of medical condition
• Refuse health care (to the extent of the law) and understand the consequences
• Decide ahead of time the care they want if they become sick, injured or seriously ill by making a living will
• Be able to make decisions about their children’s health care if members are younger than age 18 and married, pregnant or have children

1. Grievances, Appeals, and Fair Hearings

• Pursue resolution of grievances and appeals about the health plan or care provided
• Freely exercise filing a grievance or an appeal without adversely affecting the way they are treated
• Continue to receive benefits pending the outcome of an appeal or a fair hearing under certain circumstances

1. Medical care

• Choose their PCPs from our network of providers
• Choose any Anthem network specialist after getting a referral from their PCPs, if appropriate
• Be referred to health care providers for ongoing treatment of chronic disabilities
• Have access to their PCPs or backups 24 hours a day, 365 days a year for urgent or emergency care
• Get care right away from any hospital when their symptoms meet the definition of an emergency medical condition
• Get post stabilization services following an emergency medical condition in certain circumstances
• Be free from discrimination and receive covered services without regard to race, color, creed, gender, religion, age, national origin ancestry, marital status, sexual preference, health status, income status, program membership, or physical or behavioral disability, except where medically indicated 

Members’ Rights and Responsibilities

Serra annually distributes the Members’ Right and Responsibilities Statement to all Physicians annually. Members’ Rights and Responsibilities are posted on every floor within Serra.

Quality Improvement (QI) Activities

You can request a hard copy of Serra’s QI Activities, Program Descriptions and Annual Evaluations, upon request.

QI Results

Member Satisfaction Survey Results

Provider Satisfaction Survey Result

QI Program Plans and Annual Evaluations

Program/Services

Access to Care Standards

Access to Care Standards

Serra must ensure that all Physicians and Providers comply with the Access to Care Standards, which assures that our members have 24 hours/7 days a week access to our Provider Network.

Serra will ensure that our providers and physicians comply with the appointment availability, after hours and ancillary regulatory standards. Serra’s goal is to ensure that our offices are educated on these standards and this ensures our members’ have access to the needed services. If you have any questions, regarding the Access Standards, please contact the UM Dept. at (818) 504-4569.

1. Wait Times from Date of Request for Appointment

Health plan members have the right to appointments within the following time frames: