In CA know your Health Insurance Rights
In CA, your rights:
- Right to timely care. California-regulated health plans must provide appointments and telephone advice within required timeframes, including access to specialists when needed.
- Right to emergency care coverage. Your plan must cover emergency services, even if you go to an out-of-network emergency room, and emergency rooms must treat you until you are stable enough to be moved.
- Right to file a grievance or appeal. You can complain to your health plan if care, payment, or coverage is denied, delayed, or handled unfairly. If the issue is not resolved, you may escalate it to the state regulator.
- Right to an Independent Medical Review (IMR). If a plan denies, changes, or delays medically necessary treatment, Californians may request an independent review by outside medical experts through the appropriate state regulator.
- Right to continuity of care. If your doctor, medical group, or hospital leaves your network, you may be able to continue treatment with that provider for a limited period in certain situations.
- Right to a second opinion. California health plan members can request a second doctor’s opinion about a diagnosis or recommended treatment.
- Right to understand why care was denied. You have the right to know why a service or treatment was denied, modified, or delayed.
- Right to clear information about your health and treatment. You have the right to understand your condition, receive a written diagnosis, and give informed consent before treatment.
- Right to privacy of your health information. Your plan and providers must protect your personal health information under state and federal privacy rules.
- Right to language assistance. California consumer guidance states members can get interpreter help when English is not their first language.
- Right to protection from illegal balance billing, in certain situations. California guidance for members includes protection from illegal balance billing by providers.
- Right to mental health treatment when covered by law and plan terms. California specifically recognizes member rights to receive treatment for certain mental health conditions.