Patient Rights & Responsibilities

Patient Rights

At a time when denials of care seem more important than the delivery of care, Mission Pediatrics places the needs of our patients first and foremost. To make sure we’re clear on that subject, we’ve developed our own Patients’ Bill of Rights.

  • Be treated without regard to race, ethnicity, national origin, religion, sex, age, mental or physical disability or medical conditions, sexual orientation, claims experience, medical history, evidence of insurability, genetic information, or source of payment.
  • Receive healthcare services consistent with the benefits covered in their policy based on race, ethnicity, national origin, religion, sex (including gender identity or gender expression), age, mental or physical disability or medical condition, sexual orientation, claims experience, medical history, evidence of insurability (including conditions arising out of acts of domestic violence), disability, genetic information, or source of payment.
  • Be treated in a manner respectful to your personal privacy and dignity.
  • Patients shall be free from all forms of abuse and harassment.
  • Receive assistance in a prompt, courteous, respectful and responsible manner.
  • Receive care in a safe setting.
  • Receive a list of participating providers from their health plan.
  • Select a primary care provider (PCP) or change your PCP, surgeon or healthcare provider when necessary through their health plan.
  • Adolescent members reaching adulthood and still receiving pediatric care can get help in choosing an adult PCP when transitioning to a new adult provider with the assistance of their health plan.
  • Knowledge of the name of the physician who has been assigned to the patient by the health plan and the names and professional relationships of other providers who will see you.
  • Be informed by your treating provider of your diagnosis, prognosis and treatment options in terms you understand, and regardless of cost or benefit coverage.
  • Participate in decisions regarding medical care, be advised by your treating provider of the possible consequences of your decisions and refusing treatment.
  • Have no restrictions placed on any provider that precluded discussing appropriate treatment options with you. Except those restrictions placed upon them by the State of California regarding very specific subjects such as gender dysphoria and its treatment, CoVID vaccination or treatment, or what is determined as “disinformation” by the political powers guiding the Medical Board of California.  Utilization Management (UM) decisions are based on the appropriateness of care and service required for each patient’s individual needs. We do not compensate nor give incentives to physicians, UM staff or clinic personnel for the denial of service or care. Requests for coverage of services are reviewed to determine that the service is a covered benefit under the terms of the member’s plan and that the service delivered is consistent with established guidelines. In the event a request for coverage is denied, the member, or a provider acting on behalf of the member, may appeal this decision through the grievance process and, depending on the specific circumstances, to an external utilization review organization, which uses independent physician reviewers, a governmental agency or the plan sponsor.
  • Be advised if a physician or provider proposes to engage in or perform human experimentation affecting your care or treatment. The patient has the right to refuse to participate in such research projects.
  • Be referred, according to your needs, to a provider suitable to care for your condition.
  • Be assured of confidential handling of all communication and medical information as provided by law and professional medical ethics.
  • Express concerns including quality of care issues, receiving a response in a timely manner and initiating the grievance procedure through your health plan or independent practitioner association (IPA) if you are not satisfied with our resolution of your complaint.
  • Receive information about the clinic, its services, practitioners and providers, and patients rights and responsibilities.
  • Make recommendations regarding this patient rights and responsibilities policy.
  • Patients shall be free to exercise their rights without being subjected to discrimination or fear of reprisal.
  • Review determinations (approve, modify, deny) are based on Mission Pediatrics policies & procedures, CMS guidelines, Health Plan guidelines, and Milliman Care Guidelines (MCG) (clinical evidence based). To obtain a copy at any time, contact 800-700-6646.

** Guardian, patient representative or the person with medical power of attorney for the patient shall be able to exercise these rights on behalf of the patient.

If you ever have a compliment or concern, we encourage you to call or write our Customer Relations department:

Mission Pediatrics
Attn: Customer Relations
PO Box 9270
Redlands, CA 92375
(951) 779-1670
For hearing impaired services – TTY 711

You may also contact or make a formal complaint to:
California Department of Public Health
(888) 354-9203
www.cdph.ca.gov

Department of Managed Health Care at:
980 9th Street, Suite 500
Sacramento, CA 95814
(888) 466-2219
FAX: (916) 255-5241
www.dmhc.ca.gov

Medicare Patients:
Office of the Medicare Beneficiary Ombudsman
1-800-Medicare (1-800-633-4227(24 hours a day/7 days a week)
www.medicare.gov/navigation/help-and-support/ombudsman.aspx

Discrimination is Against the Law:

Mission Pediatrics complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Mission Pediatrics does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

In compliance with the Americans with Disabilities Act (ADA), qualified interpreters and other auxiliary aids and services are available free of charge to people who are deaf or hard of hearing.

 

For more information about the Americans with Disabilities Act (ADA), call the Department of Justice’s toll-free, ADA Information Line at 1-800-514-0301 (voice), 1-800-514-0380 (TTY), or visit the ADA Home Page at www.ada.gov 
Mission Pediatrics’s ADA Coordinator can be reached at (951) 782-5110.

Mission Pediatrics:

  • Provides free aids and services to people with disabilities to communicate effectively with us, such as:
    • Qualified sign language interpreters
    • Written information in other formats (large print, audio, accessible electronic formats, other formats)
    • Interpretation services where needed or requested for patients whose language is other than English.

 

 

 

Information drawn from and adapted from online standardized forms.

 

Patient Responsibilities

As a patient of Mission Pediatrics, you have both rights and responsibilities that will assist us in providing you quality healthcare that can be delivered in a courteous and sensitive manner by our physicians and staff.

  • Provide honest, complete information to those providing medical care.
  • Adhere to the Patient Policies Handbook for Mission Pediatrics
  • Honor office policies which may include wearing masks, redirected telemedicine visits or limiting the number of people accompanying the patient being seen.
  • Present your ID card before receiving service, as well as any insurance card you may have been provided that is in effect.
  • Present your or your child’s Insurance Card indicating your health insurance arrangements.
  • Present your child’s vaccination record at each well child examination appointment.
  • Responsible for informing your provider of a Restraining Order, Court Ordered Custody Arrangement, Living Will or Advance Directive, or any document that could affect care.
  • Know the benefits and exclusions of your health insurance coverage.
  • Know how to access services in routine, urgent and emergency situations.
  • Consult your Treating Provider which may include a physician, physician assistant, or nurse practitioner for direction of care before receiving treatment (unless in a life-threatening situation).
  • Keep scheduled appointments and notify the provider’s office promptly if you are delayed or cannot keep an appointment. (Charges may be incurred for missed appointments that are not canceled 24 hours in advance.)
  • Establish an ongoing rapport with your Treating Provider which may include a physician, physician assistant, or nurse practitioner and behave in a manner that supports the care provided to others and the general function of the facility.
  • Ask questions and seek clarification to understand your health problems and participate in mutually agreed upon treatment goals.
  • Follow the advice of your Treating Provider which may include a physician, physician assistant, or nurse practitioner and consider the likely consequences when you refuse to comply.
  • Know what medications, including over-the-counter products and dietary supplements, why you are taking them and how to take them. Know what allergies and sensitivities you may have. Make sure your provider is aware of medications and allergies/sensitivities.
  • Notify your provider of changes in address, phone number, email and insurance information in a timely manner.
  • Make payment of all services or non-covered services and applicable co-payments at the time service is provided.
  • Make us aware of any concerns you have regarding the care you were provided by calling or contacting customer service.  CustomerService@MissionPediatrics.com
  • Supply information that the clinic and its practitioners and providers need in order to provide care.
  • Be respectful and courteous to clinic staff and other patients.
  • Provide a responsible adult to transport a patient home and stay with them for up to 24 hours if required by physician.

If you ever have a compliment or concern, we encourage you to call or write our Customer Relations department at:

Mission Pediatrics, Inc.
Attn: Customer Relations

PO Box 9270
Redlands, CA 92375
(951) 683-6370

For hearing impaired services – TTY 711. To access language or LEP (Limited English Proficiency) services at no cost to you, call the number on your insurance ID card or call: (951) 779-1670 to request assistance

If we have not satisfactorily resolved your concern, you may make a formal complaint by contacting:

California Department of Public Health
(888) 354-9203
www.cdph.ca.gov

Managed care patients may contact California Department of Managed Health Care at:
California Department of Managed Health Care
980 9th Street, Suite 500
Sacramento, CA 95814
(888) 466-2219
www.dmhc.ca.gov

Seniors may contact the Office of the Medicare Beneficiary Ombudsman at:
https://www.cms.gov/Center/Special-Topic/Ombudsman/Medicare-Beneficiary-Ombudsman-Home
1.800.Medicare (1.800.633.4227(24 hours a day/7 days a week)

 

 

Information drawn from and adapted from online standardized forms.

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