Member rights and responsibilities

The delivery of health care depends upon a partnership between the member and their primary care physician (PCP). As a member, you have certain rights and responsibilities and we believe it is vital that you understand them in order to get the most out of your health care experience.


We’ve made it easy for you to access information on a variety of topics by viewing the Scripps Health Plan member rights and responsibilities section in the New Member Welcome Guide.


Information regarding policies and review guidelines

You or your designated representative have the right to request information about the operational policies and clinical review criteria used by Scripps Health Plan to coordinate your health care needs. You or your designated representative may obtain a copy of the benefit provision, guideline, protocol or other similar criterion on which the denial decision was based, free of charge, by calling Scripps Health Plan at 844-337-3700 or TTY/TDD at 888-515-4065 (for the hearing and speech impaired).


Public policy committee

As a Scripps Health Plan member, you have the right to participate in a Public Policy Committee.


The committee provides an opportunity to provide feedback regarding acts performed by a plan or its employees and staff to assure the comfort, dignity and convenience of patients who rely on the plan’s facilities to provide health care services to them, their families and the public.


Participating in the Public Policy Committee is not to be used as a substitute for the grievance procedure, complaints, inquiries or requests for information.


At least one third of the Public Policy Committee is comprised of members who are not employees, providers, subcontractors or group contract brokers and who do not have financial interests in Scripps Health Plan.

 

Participation is voluntary. If you are interested in participating in the Public Policy Committee, please contact Scripps Health Plan's Compliance Officer at 858-927-5360.