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.
- 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, if necessary.
- 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 RMC policies & procedures, CMS guidelines, Health Plan guidelines, and Apollo guidelines (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 at:
Riverside Medical Clinic
Attn: Customer Relations
3660 Arlington Avenue
Riverside, CA 92506
For Southern California Residents Call Toll Free
You may also contact or make a formal complaint to:
California Department of Public Health
Department of Managed Health Care at:
980 9th Street, Suite 500
Sacramento, CA 95814
Office of the Medicare Beneficiary Ombudsman
1-800-Medicare (1-800-633-4227) (24 hours a day/7 days a week)