Print
Skip Navigation Links OPA Home How to Use Your Health Plan Problems and Complaints Speak Up for Yourself

Speak Up for Yourself

Tips for self-advocates

  • Act promptly.
  • Be persistent.
  • Take notes on your calls.
  • Get the names of people you talk to.
  • Have someone with you for support.
  • Ask to speak to a supervisor.
  • Denied care? Ask for the reason in writing.

There are things you can do if you are not happy with your care or cannot get a needed service.

Topics on this page

Ask a doctor to help you

The doctor can help you explain why you need the care. This is important for a successful complaint. The doctor does not have to be part of your plan.

Find a consumer assistant or advocate

Call a consumer assistance group. You can also ask your benefits office at work for help.

If your plan says a service is not covered

Your plan may refer you to documents about your benefits. Ask the plan to send you the documents. Ask what page to look on, or ask them to highlight the part that says the service is not covered.

  • The Summary of Benefits is a short list of benefits and common charges.
  • The Evidence of Coverage (EOC) is an explanation of your benefits and services.
  • Most plans say that they do not cover experimental treatments. However, in California you can ask for an Independent Medical Review   of this denial. Your condition must be serious.

Back to the Top

 


Links with this symbol External link symbol link to external sites. OPA cannot endorse the quality or accuracy of information contained on other sites.