Patient Resources


Local Health Insurance Resources

www.solanocoalition.org

Solano Coalition for Better Health provides free assistance to Solano County residents interested in Covered California or other affordable health care options, including the Solano Kids Insurance Program (SKIP) which helps kids get the coverage they need by assisting families to enroll their children into Medi-Cal and Healthy Families programs, or into the Healthy Kids Solano program for those children who do not qualify for state-sponsored care.

http://www.solanocoalition.org/


Children Health Initiative Napa County

Children's Health Initiative of Napa County offers health insurance enrollment and re-enrollment assistance to pregnant women and children from birth through age 18. The health insurance programs we work with are free or no-cost for eligible families and include medical, dental, vision and mental health coverage.

Launched in 2005 to ensure that all children in our community have access to comprehensive, quality healthcare, community and business leaders, healthcare providers, educators, child advocates and foundations have come together to create an innovative, public-private partnership that offers an effective and lasting solution to the healthcare crisis for our most vulnerable children and families.

http://www.napachi.org/

Advance Care Planning Resources

What is Advance Care Planning? Advance Care Planning is the process of reflecting on, discussing, and planning for a time when we may be unable to communicate our own medical preferences. Whether the cause is an accident, the late stage progression of a chronic disease, or the natural consequences of serious illness or aging, Advance Care Planning is crucial to help our physicians, families, and friends honor our healthcare preferences if we are unable to speak for ourselves.

Advance Care Planning is an outgrowth of the Palliative Care and Hospice movements. Originally, palliative care focused on providing a dignified, empowered dying process with well-controlled pain. With the increasing availability of sophisticated but sometimes burdensome life support technologies and treatments, palliative care has expanded to include discussions and planning with patients to empower them to make decisions about intensity of care at all stages of life. Advance Directives, Healthcare Agents, Chronic Disease Management, and POLST forms are Advance Care Planning tools that help ensure our healthcare preferences are known and honored at all life stages.

Below are resources available in the community as well as information from state organizations.

Napa Valley Hospice Adult Day Services    Honoring Choices Napa Valley

Honoring Choices Napa Valley (HCNV) is a coalition of organizations and individuals in Napa County committed to promoting Advance Care Planning to facilitate informed healthcare decision making at all stages of life. Our vision is for all adults in Napa County will receive health care based on previously expressed personal and cultural values and preferences regarding aging, illness, and end-of-life care.

We seek a significant shift in the knowledge, behaviors, and attitudes of Napa County residents regarding Advance Care Planning, advanced illness, and the end of life.

http://hcnv.org/


The Coalition for Compassionate Care of California (CCCC) promotes high-quality, compassionate care for all Californians who are seriously ill or approaching the end of life.

CCCC is a statewide collaborative of organizations and individuals representing healthcare providers, assisted living facilities, nursing homes, hospices, consumers, state agencies and others.

  • Provide our expertise, tools and resources to families, patients, policy makers and healthcare providers to help ensure that all Californians receive high-quality palliative and end-of-life care.
  • We lead efforts to train healthcare professionals about Physician Orders for Life-Sustaining Treatment (POLST), as well as cultural diversity and end-of-life care in California. We help them develop the skills they need to talk with seriously-ill patients and families facing decisions about goals of care.
  • We work with and support local coalitions throughout the state that provide support and education to healthcare providers and those facing treatment and care decisions.
  • We bring together people with a passion for increasing access to palliative care to spark growth of community-based palliative care throughout California.

http://coalitionccc.org/



Physician Orders for Life-Sustaining Treatment (POLST) is a form that gives seriously-ill patients more control over their end-of-life care, including medical treatment, extraordinary measures (such as a ventilator or feeding tube) and CPR. Printed on bright pink paper, and signed by both a doctor and patient, POLST can prevent unwanted or ineffective treatments, reduce patient and family suffering, and ensure that a patient's wishes are honored.

http://capolst.org/

Patient Access to Medical Records

Patients are legally entitled to copies of their medical records for a reasonable fee. To request copies of your medical records, contact your physician directly.

The Medical Board of California consumer site provides detailed information: click here

Dispute Resolution

As a patient and a consumer, there may be times when you’re dissatisfied with the care you are receiving – whether by a personal physician, hospital, or your insurer. Some problems can be resolved informally simply by talking to the parties involved, but others will require that you follow an official set of "grievance procedures." It’s important to try and resolve a problem, particularly when it affects your health. Depending on the issue, there are many independent organizations that can assist in difficult situations.

Patient Complaints with Hospital and Inpatient Facilities

If you're having a problem with a hospital or other health care facility, the first step is to contact their "patient complaint coordinator." If you do not get a satisfactory response and would like to take further action, the government agency responsible for licensing and regulating hospitals is the California Department of Public Health (CDPH). To file a complaint with CDPH, fill out the online consumer complaint form. If your complaint involves a facility in El Dorado, Placer, Sacramento or Yolo counties, you may also contact the CDPH Licensing and Certification District Office at (800) 554-0354.

Patient Complaints with Health Plans

If you have a problem with your health plan, you have the right to file a complaint. A complaint is also called a grievance or an appeal. The rules and procedures for filing a complaint will vary based on the type of plan. Contact your health plan for information on accessing the plan’s formal dispute process. If you then do not get resolution, and depending on what type of health insurance you have, there are two state agencies with which you can file a complaint against your health plan:

The Department of Managed Health Care (DMHC) regulates all HMOs, plus Blue Shield of California PPO and Anthem Blue Cross of California PPO. These plans are subject to regulation under the Knox-Keene Act. To file a complaint, contact DMHC’s Help Center at (888) HMO-2219, TDD (877) 688-9891 or visit the DMHC website.

You can also contact DMHC by mail at:
Department of Managed Health Care
Help Center
980 9th Street, Suite 500
Sacramento, CA 95814-2725

The Department of Insurance (DOI) regulates PPOs (except Blue Cross and Blue Shield PPOs) and other non-HMO insurers. DOI investigates complaints, prosecutes insurers when appropriate and responds to complaints and inquiries by members of the public concerning the handling of insurance claims or alleged misconduct by insurers.

If you have a complaint about a health insurer, the first step is to contact the insurance company in an effort to resolve the issue. If you need help with a grievance involving an emergency or that has not been satisfactorily resolved by your insurer, you may contact DOI for assistance at (800) 927-HELP (4357), TDD (800) 482-4833 or by completing an online complaint form.

You can also contact DOI by mail at:
California Department of Insurance
Consumer Communications Bureau
300 South Spring Street, South Tower
Los Angeles, CA 90013

Medicare Patient Grievances

Medicare patients are entitled to special grievance and appeal rights. Medicare HMOs, competitive medical plans, and health care prepayment plans are required by law to give you a complete written explanation of your grievance and appeal rights. The Medicare website, www.medicare.gov, is also helpful. Information on appeals can be found here.

HICAP (the Health Insurance Counseling & Advocacy Program) provides free and objective information and counseling about Medicare. Volunteer counselors can help you understand your specific rights and health care options. Contact HICAP at 1-800-434-0222 or click here.

Physician Disputes

If you are unhappy with something your doctor has said or done, it's important that you speak to him or her about it as soon as possible, especially if it concerns your health. Often, a frank conversation is enough to solve the problem.

The Napa and Solano County Medical Societies may be able to assist in mediating disputes between patients and individual physicians. If you are experiencing difficulties with a physician, a complaint form must be completed and your signature is required for release of medical information pertinent to your complaint. The physician will be notified of your complaint. If needed, our Professional Conduct & Ethics Committee will review your complaint and inform you of its recommendations.

Please note: This is a confidential, peer-review advisory process; disciplinary action can only be taken by the Medical Board of California (MBC). To file a complaint with the MBC, call (800) 633-2322 or visit www.medbd.ca.gov.

Medical Board of California (MBC)

The Medical Board of California is a state regulatory agency charged to protect health care consumers through the proper licensing and regulation of physicians and surgeons and certain allied health care professions and through the vigorous, objective enforcement of the Medical Practice Act, and, to promote access to quality medical care through the Board's licensing and regulatory functions.

The Medical Board of California is the only authority in the state that may take disciplinary action against the license of the physician(s) to whom your complaint relates. Visit their website at www.mbc.gov or call 1-800-633-2322 toll free. The MBC is located at 2005 Evergreen Street, Suite 1200, Sacramento, CA 95815.