Our members

Please review the tabs below for information relating to members.

Contacting IMS

*IMS provides language assistance, free of charge, in the requested language through bilingual staff or an interpreter.

To request copies of policies and procedures:
During Business Hours: Customer Service Department at 323-800-8283
After-hours: UM Department 1-800-285-6164 (toll free)
Policies will be delivered within five (5) business days from request date.

IMS offers Telecommunications Relay Services (TRS):
TRS permits persons with a hearing or speech disabilities to use the telephone system via a text telephone (TTY). Simply dial 711 to be automatically connected to a TRS operator. It’s fast, functional and free. Dialing 711, can initiate a call from any telephone in the United States, without a seven or ten-digit access number.

Video and Internet-based relay services:
711 dialing access does not work for Video Relay Service, Internet Protocol Relay or IP Captioned Telephone Service Relay calls. Hearing persons initiating a VRS or IP Relay call may do so by calling a provider’s 800 number. IPCTS users should call their party directly and a communications assistant will be automatically connected to the call.

To anonymously report compliance concerns:
Compliance Hotline (Available 24 hours a day): 844.359.3410
Compliance Fax: 323.832.8141

Member Rights and Responsibilities

As member/patient of IPA, you have many key rights and important responsibilities. IPA is committed to seeing to your rights be respected at all times—by upholding your responsibilities, you can ensure a satisfying member experience.

  • To exercise your rights without regard to race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information or source of payment
  • To be treated with respect, and with recognition of your dignity and privacy
  • To be provided with information about your IPA, its services and the healthcare service delivery process
  • To be informed of the name, qualifications and titles of the physician that has primary responsibility for coordinating your care, and to be informed of the names, qualifications and specialties of other professionals who may be involved in your care
  • To have 24-hour access to your primary care physician (PCP) or covering physician
  • To receive complete information about the diagnosis, proposed course of treatment or procedure, alternate courses of treatment or non-treatment, the clinical risks involved in each, as well as prospects for recovery in terms that are understandable to you
  • To be informed of continuing healthcare requirements following office visits, treatments, procedures and hospitalizations
  • To actively participate in decisions regarding your healthcare and treatment plan. To the extent permitted by law, this includes the right to refuse any procedure or treatment (if refused, an explanation will be given by your provider and will address the effect(s) that this will have on your health)
  • To have access to personal medical records based upon state and federal requirements
  • To be informed of non-emergent costs of care and receive an explanation of your financial obligations prior to incurring the expense (including co-payments, deductibles and co-insurance)
  • To examine and receive an explanation of bills generated for services delivered to you
  • To be informed of applicable rules in the various healthcare settings regarding member conduct
  • To express opinions or concerns regarding your IPA or the care provided; to offer recommendations for change in the healthcare delivery process by contacting your IPA Member Services Department; to have a timely and organized system for resolving member complaints and formal grievances
  • To be informed of the member grievance and appeals process
  • To change your PCP by contacting your health plan
  • To receive reasonable continuity of care and be given timely and sensible responses to questions and requests made for service
  • To be able to formulate advanced directives for healthcare

These member rights shall apply to any person that has legal responsibility to make healthcare decisions for you. Members also have the right to be represented by parents, guardians, family members or other conservators if they are unable to fully participate in their own treatment decisions.

HIPAA

The Health Insurance Portability and Accountability Act was created to:

  1. modernize the flow of healthcare information
  2. stipulate how Personally Identifiable Information maintained by the healthcare and healthcare insurance industries should be protected from fraud and theft
  3. address limitations on healthcare insurance coverage

The Security Rule including who is covered, what information is protected, and what safeguards must be in place to ensure appropriate protection of electronic protected health information.

Interpreter Services

Interpreter Services are available for those who do not speak fluent English and those who have visual, speech, or hearing impairments to safely receive their medical information and care. Innovative Management Systems and your Health Plan work together to ensure effective communication between our staff and patients.

Access Transportation

Access Paratransit operates seven days a week, 24 hours of the day in most areas of Los Angeles County. It is a shared ride service that is curb-to-curb and utilizes a fleet of small buses, mini-vans and taxis. Fares are distance-based and range from $2.75 to $3.50 for each one-way trip. Personal Care Attendants may ride with the qualified rider for free. Different fares may be charged in the Antelope Valley and Santa Clarita Valley service areas.

Affirmative Statement

IMS employees who are in the position to review, conduct or make medical decisions are not influenced by financial incentives, bonuses or additional compensation relating to the quality of, access to, or Utilization of Health Care services rendered to enrollees. Physician reviewers are not rewarded for issuing denials of coverage. All decisions are reviewed using evidence-based guideline criteria and/or the members Health Plan/IPA Evidence of Coverage benefit.

To discuss denials, obtain an appeal, or discuss criteria please contact our Customer Service Team at 323-800-8283.

Obtaining Decision Making Criteria

Providers/Members requesting clinical criteria related to a Utilization referral decision is available to Members, Providers and the public and may be requested by contacting the Utilization department, fax, portal or by phone request 323-800-8283.  The criteria will be delivered within one (1) business day of the request.

Community Based Services

Coming soon

FAQ

Coming soon

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