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Member Support

Members Rights & Responsibilities

As a member of Torrance Health IPA, you have the right to:

  • Receive information about THIPA, its services, its practitioners and providers.
  • Be treated with respect and dignity.
  • Personal privacy
  • Participate with practitioners in decision-making regarding your health care.
  • Candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage.
  • Request a copy of THIPA's policies, procedures, and criteria used to make referral decisions by phoning THIPA member services department.
  • Voice complaints or appeals about THIPA or the care provided.
  • Make recommendations regarding THIPA's members' rights and responsibilities policies.
  • Request translation services, interpretative and/or auxiliary aide services (for the sensory impaired) at no cost, to ensure that you have an equal opportunity to access and participate in all services. You have the right to a certified medical interpreter or sign language interpreter to translate health information accurately, who must respect your privacy and keep all information confidential.

As a member of Torrance Health IPA, you have the responsibility to:

  • Supply information (to the extent possible) that THIPA and its practitioners and providers need in order to care for them.
  • Follow the plans and instructions for care that they have agreed on with their practitioners.
  • Understand their health problems and participate in developing mutually agreed upon treatment goals to the degree possible.
  • Be represented by parent, guardians, family members or other conservators for those who are unable to fully participate in their treatment decisions.

Distribution of Members' Rights and Responsibilities Policy Statement:

  • Member Information - Members who have already sought medical services from THIPA practitioners/providers who need additional information on how to obtain care are informed through THIPA's member services department.
  • A list of our practitioners and providers with their addresses and telephone numbers is provided to members upon their request and is also available on www.thipa.org/Doctors.

Claims, Appeals, or Grievances

You can file a Grievance and Appeal with your Health Plan by Phone, Mail, Fax and Online. Click on: "Health Plan Grievance Info" for a list of all Health Plans contracted with THIPA with instructions on how to file a Grievance and Appeal with each of them.

If you need further assistance, Call:

THIPA Member Services
Toll-Free: 1-866-568-4472
Monday - Friday: 8:30 a.m. - 5:00 p.m.

When you call Member services at the Toll Free number above, feel free to ask for the Member Services Representative who is specialized in your health plan.

Affirmative Statement About Incentives

Utilization Management (UM) decision-making is based only on appropriateness of care and service and existence of coverage.

THIPA does not specifically reward practitioners or other individuals for issuing denials of coverage or service care.
There are no financial incentives for UM decision-makers; therefore there is nothing to encourage decisions that result in underutilization.

All requested service(s) or medical care for members of THIPA, are based solely on what is appropriate and a covered benefit for the member as detailed by his or her health plan.

Language Assistance Program

Request interpreter services

If your patient needs interpreter services for any language, call Provider Services at (800) 541-6652. California health plans provide free of charge to all their members, oral interpretive services to LAP members at all medical points of contact. This does not apply to senior members.

Health Plan Oral Translation Services

Aetna


Oral Interpretation Contact Number


Aetna logo (877) 287-0117

Anthem Blue Cross


Oral Interpretation Contact Number


Anthem Blue Cross logo (888) 254-2721

Blue Shield of CA


Oral Interpretation Contact Number


Blue Shield of CA logo (866) 346-7198

Care 1st Health Plan


Oral Interpretation Contact Number


Care 1st Health Plan logo (800) 544-0088

Cigna


Oral Interpretation Contact Number


Cigna logo (800) 244-6224

Health Net


Oral Interpretation Contact Number


Health Net logo (800) 546-4570

After Hours Interpreter Assistance
(6:00 pm- 8:00 am)

Humana


Oral Interpretation Contact Number


Humana logo (800) 457-4708

Scan Health Plan


Oral Interpretation Contact Number


Scan Health Plan logo (800) 559-3500

United Healthcare


Oral Interpretation Contact Number


AARP Medicare Complete logo (800) 624-8822

Tips for Working with Telephonic Interpreters

Telephonic interpreter services allow for immediate contact with a professional interpreter. Here are some strategies to optimize communication:

  • If possible, speak to the interpreter privately prior to the contact, providing relevant information regarding the member and the important information to convey.
  • Interpreters are not allowed to rephrase or clarify. Encourage the interpreter to request clarification or to redirect explanations as needed.
  • Direct the conversation to the member, not the interpreter.
    • Use short sentences limited to a single concept if possible.
    • Allow adequate time for the interpreter to convey the information in the member’s language.
  • Avoid medical jargon or technical explanations unless they are requested by the member.
    • Avoid interrupting the interpreter.

If the member’s non-verbal cues indicate confusion, ask the member to summarize or restate what has been communicated.

We at Torrance Health IPA sincerely hope this information is useful in your everyday encounters with Limited English Proficient members.