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The California Office of the Patient Advocate
Guiding you to better health care
The California Office of the Patient Advocate
has materials and information on its website
to help you become your own best advocate
so that you get the most out of your healthcare.
If you’re having problems with your health plan
it’s also important to know about the Help Center
The Help Center is available to provide assistance
at no cost to you.
The Help Center is a free resource that helps Californians
if they have questions or problems with their health plans.
The Help Center is there. It's a great resource
So if you have a problem with your health plan
or you have questions or if there is a urgent issue that
you can't resolve, you can contact the Help Center
These people are experts
Some people think that we are a part of the health plan
but we are not.
We are part of the Department of Managed Health Care
The state agency that is responsible for making sure that
Health Plans follow the law and provide the health care services
that members of those health plans have a right to
A consumer in a California managed care plan
should call the Help Center if they are having ANY kind of problem or
any kind of question about their Health Plan
The Help Center oversees California HMOs
and certain other Heath Plans in the state
The Help Center makes sure that Health Plans follow the law
and that health plan members get the right care at the right time
If the Health Plan denies a service or treatment
the Help Center can conduct an independent medical review
or IMR
where doctors not affiliated with the patient's Health Plan
review the denial
It's always been my concern that
the consumer will get a denial letter from their health plan and
think that that is their last chance.
It is not
The no doesn't mean no. What the no is is the starting place
because one a grievance or complaint has been received
by the plan, the no starts the official process of
determining when the consumer can seek our assistance
The Help Center's trained professional staff
including nurses and attorneys
are there to help you. The process of contacting the Help Center
and filing a complaint or requesting an IMR
Is designed to be as simple and accessible as possible
Contact with the call center and going through any of our complaints processes
Is a completely free service and a very easily navigated service
Our complaint forms and our independent medical review forms
are very simple in nature
they don't require a medical professional to complete these types of forms
Medical language isn't necessary
they are very basic information
On staff Registered Nurses research medical and clinical issues
associated with complaints
Our nurses are a vital part of the service that we offer here
Our nurses do provide urgent response to consumer needs
needs that would put them at health risk
If we did not intervene in an expedited manner
The Help Center's attorneys will advocate on your behalf to
help resolve the issue with your help plan
What's wonderful about the Help Center is that
there are teams of skilled attorneys
at no cost to the enrollees that advocate on behalf of them
and their issues.
We're an accessible resource
The consumers freely contact us and we discuss with them
their complaints and advocate with them and for them.
The Help Center is here if you're having a problem with your health plan.
Such as not getting a treatment, medical equipment or prescription
Weather you're waiting too long for a specialist appointment
in a billing dispute or feel like your being sent home from the hospital too soon
Filing a complaint with the Help Center is easy
If you're not satisfied with your health plan
Step one is to contact the health plan
and file a complaint
If you're not satisfied with the health plan's decision on your complaint
Step 2 is to Contact the Help Center
You can contact the Help Center by visiting the website or calling toll free
For urgent issues, an answering service is available 24 hrs a day
Bilingual staff and interpreter services allow the help center in 150 languages
I think the service we provide is exceptional
and that California consumers are really lucky that they have
a state agency that will work so hard for their individual complaint
We hear all the time that people say
I had no idea this Help Center was here.
I had no idea the state of California had this type of service at no cost
We're hoping that this really gets out to people so that they know
if they ever had a problem with their health plan
there is a place to go to make sure that health plans follow the law
and provide the care that enrollees are entitled to.
To learn more about the Help Center,
visit the website at HealthHelp.CA.GOV
or call 1-888-466-2219
For more information and resources
about getting the most out of your health care,
visit the Office of the Patient Advocate’s website at
OPA.CA.GOV