Patient Rights

At a time when denials of care seem more important than the delivery of care, Riverside Medical Clinic 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.
• Select a primary care provider (PCP) or change your PCP, surgeon or healthcare provider when necessary.
• Adolescent members reaching adulthood and still receiving pediatric care can get help in choosing an adult PCP.
• Knowledge of the name of the physician who has primary responsibility for coordinating your care and the names and professional relationships of other physicians 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. 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 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 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 Riverside Medical Clinic 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:

Riverside Medical Clinic
Attn: Customer Relations
3660 Arlington Avenue
Riverside, CA 92506
(951) 683-6370
For hearing impaired services – TTY 711

For Southern California Residents Call Toll Free
(844-550-5721)

You may contact us or make a formal complaint by completing the Grievance Form and sending to:

Riverside Medical Clinic
c/o Quality Assurance
3660 Arlington Ave.
Riverside, CA 92506
Download the Grievance Form (PDF) →

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:

Riverside Medical Clinic complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Riverside Medical Clinic 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
Riverside Medical Clinic’s ADA Coordinator can be reached at (951) 782-5110.

Riverside Medical Clinic:

• 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)
  • Provides free language services (qualified interpreters, information written in other languages) to those people whose primary language is not English, such as: Spanish, Chinese, Mandarin, Chinese Cantonese, Tagalog, French, Vietnamese, German, Korean, Russian, Arabic, Italian, Portuguese, French Creole, Polish, Hindi, and Japanese

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) 683-6370

Para acceder a los servicios de idiomas sin costo, llame al número que figura en su tarjeta de identificación. (Spanish)

如欲使用免費語言服務，請致電您 ID 卡上的電話號碼 (Chinese)

Nếu quý vị muốn sử dụng miễn phí các dịch vụ ngôn ngữ, hãy gọi tới số điện thoại ghi trên thẻ ID (Nhận dạng) của quý vị. (Vietnamese)

Para ma-access ang mga serbisyo sa wika nang wala kayong babayaran, tawagan ang numero sa inyong ID card. (Tagalog)

무료 언어 서비스를 이용하려면 보험 ID 카드에 수록된 번호로 전화해 주십시오. (Korean)

Անվճար լեզվական ծառայություններից օգտվելու համար զանգահարեք ձեր ինքնության (ID) քարտի վրա նշված հեռախոսահամարով: (Armenian)

برای دسترسی به خدمات زبان به طور رایگان، با شماره قید شده روی کارت شناسایی خود تماس بگیرید. ) Persian-Farsi )

Для получения бесплатной помощи переводчика позвоните по телефону, указанному на Вашей личной карточке медицинского страхования. (Russian)

言語サービスを無料でご利用いただくには、IDカードに記載の番号にお電話ください。(Japanese)

للحصول على الخدمات اللغویة دون أي تكلفة، الرجاء الاتصال على الرقم الموجود على بطاقتك الشخصیة. ) Arabic )

ਤੁਹਾਡੇ ਲਈ ਬਿਨਾਂ ਬਿਸੇ ਿੀਮਤ ਵਾਲੀਆਂ ਭਾਸ਼ਾ ਸੇਵਾਵਾਂ ਦੀ ਵਰਤੋਂ ਿਰਨ ਲਈ, ਆਪਣੇ ਆਈਡੀ ਿਾਰਡ ‘ਤੇ ਬਦਿੱਤੇ ਨੰਿਰ ਤੇ ਫ਼ੋਨ ਿਰੋ। (Punjabi)

ដ ើម្បីទទួលបានដេវាកម្មភាសាដ លឥតគិតថ្លៃេម្រាប់ដោកអ្នក េូម្ដៅទូរេ័ព្ទដៅកាន់ដលខដ លានដៅដលើប័ណ្ណេាាល់ខលួនរបេ់ដោកអ្នក។ (Mon-Khmer, Cambodian)

Xav tau kev pab txhais lus tsis muaj nqi them rau koj, hu tus naj npawb ntawm koj daim npav ID. (Hmong)

आपके लिए बिना ककसी कीमत के भाषा सेवाओं का उपयोग करने के लिए, अपने आईडी काडड पर दिये नम्िर पर कॉि करें। (Hindi)

หากท่านต้องการเข้าถึงการบริการทางด้านภาษาโดยไม่มีค่าใช้จ่าย โปรดโทรหมายเลขที่แสดงอยู่บนบัตรประจาตัวของท่าน (Thai)

If you need these services, contact:

Riverside Medical Clinic Customer Relations Department: 951‐782‐3602

If you believe that Riverside Medical Clinic has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:

Riverside Medical Clinic
Customer Relations Department
3660 Arlington Avenue
Riverside, CA 92506

(951) 782‐3602

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) 683-6370

You can file a grievance in person or by phone. If you need help filing a grievance, Riverside Medical Clinic Customer Relations Department is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf or by mail or phone at:

U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
800‐368‐1019
800‐537‐7697 (TDD/TTY)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html

Title 16 of California Code of Regulations (CCR) Section 1355.4
NOTICE TO PATIENTS
Medical Doctors are licensed and regulated by the Medical Board of California. To check up on a license or to file a complaint go to www.mbc.ca.gov email: [email protected] or call: 800-633-2322