North American Medical Management - California
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NAMM Member Bill of Rights

Dignity & Respect

You have the right to be treated with consideration, dignity and respect - and the responsibility to respect the rights, property and environment of all physicians and other health care professionals, employees and other patients.

You have the right to access your own medical records and to have the privacy and the confidentiality of those records maintained.

You are also entitled to exercise these rights regardless of gender, sexual orientation, marital status or culture, economic, educational or religious background.

Knowledge & Information

You have the right - and the responsibility - to know about and understand your health care and your coverage, including:

  • How your health plan operates - as stated in your Member Handbook and Evidence of Coverage.
  • Participating actively in decisions regarding your medical care. Having participated in and agreed to a treatment plan, you have a responsibility to follow the treatment plan or advise your physician otherwise.
  • The names and titles of all physicians and other health care professionals involved in your medical treatment.
  • Your medical condition and health status.
  • Responsibility to understand your health problems and participate in developing mutually agreed upon treatment goals, to the degree possible.
  • Any services and procedures involved in your recommended course of treatment.
  • Receive information about our organization, its services, its practitioners and providers and members’ rights and responsibilities, including making recommendations regarding these member rights and responsibilities.
  • A candid discussion of appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage.
  • Any continuing health care requirements following your discharge from the physician's office or from the hospital.
  • The medications prescribed for you - what they are, what they are for, how to take them properly and possible side effects.

Member Resources

As a partner with those involved with your care; your health plan, your physician, and other health care professionals who may be involved in your care, you have the right to:

  • Contact the medical group customer service department for questions/concerns regarding:
    • Authorization status
    • Medical Group information. (Contracted physicians, hospitals, lab services, radiology, etc.)
    • Complaints
    • Receiving bills/statements
    • General questions
  • Contact your health plan member services department for questions/concerns regarding:
    • Eligibility Information
    • Benefits/co-pay information
    • Formal grievances
    • Appeal for denial of claims/requested services
    • Receiving bills/statements
    • General questions
  • Your Primary Care Physician should be contacted with any questions regarding any medical advice or prescribed treatment if you need an explanation or want more information.

Member Responsibility

As a partner in your own health care, you have the right to refuse treatment - providing you accept responsibility and the consequences of such a decision - and the right to complete an Advance Directive as well as to refuse to participate in any medical research projects.

  • You also have the responsibility to:
    • Identify yourself by presenting your current health plan ID card (to physician, laboratory, hospital, etc.) when receiving medical services.
    • Providing your current primary care physician with all previous medical records as well as providing accurate and complete medical information to all physicians and other health care professionals involved in the course of your treatment.
    • Be on time for all appointments and to notify your physicians office as far in advance as possible if you need to cancel or reschedule an appointment.
    • Receive all non-emergent or urgent care through your assigned primary care physician (PCP), obtain a referral from your PCP for specialty care and cooperate with all persons providing you with medical care.To access your urgent care facility, visit nammcal.com choose your IPA/Group (PrimeCare, Mercy Physicians, Coachella Valley Physicians, Primary Care Associates Medical Group, or Valley Physicians Network). Refer to the facility information on the IPA/Group website or directory for Urgent Care locations in your area.
    • Notify your health plan as well as Primary Care Physician within 48 hours - or as soon as possible - if you are hospitalized or receive emergency or out-of-area urgent care.
    • Pay all required co-payments at the time you receive health care services.
  • You have the right at any and all times to contact the Customer Service Department for assistance with issues regarding your health plan.
  • It is your right to have all the above rights apply to the person you have designated with legal authority to make decisions regarding your health care.



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