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Participant Handbook PARTICIPANT HANDBOOK City and County of San Francisco Department of Public Health Updated October 2013 www.healthysanfrancisco.org Contents About this Handbook ........................... 1 Staying Healthy .................................. 16 What is Healthy San Francisco? ........... 1 Before Visiting Your Your Medical Home ................................ 3 Medical Home ..................................... 16 Your ID Card ........................................... 4 While You are at Your Medical Home ..................................... 17 Order a Replacement ID Card ............... 5 Before Leaving Your Medical Home ...... 18 Make an Appointment at Your Medical Home ....................................... 5 Participant Fees .................................. 19 Reporting a Complaint ........................... 6 Point of Services Fees ......................... 20 Health Care Services Provided by Time to Renew .................................... 21 Healthy San Francisco .......................... 7 Resources and Primary and Preventive Care .................. 7 Important Contacts ............... Back Cover Specialty Care ........................................ 7 Urgent Care .......................................... 8 Ambulance Services ............................... 8 Emergency Care .................................... 9 Mental Health Services .......................... 9 Alcohol & Drug Treatment ................... 10 Hospital Care ...................................... 10 Family Planning ................................... 13 Durable Medical Equipment ................ 13 Lab Tests ............................................. 14 Pharmacy ............................................ 14 Services Not Included .......................... 15 About this Handbook Healthy San Francisco is On the following pages, you’ll find helpful Not Health Insurance information about your participation in Healthy Healthy San Francisco provides basic and San Francisco. This Handbook was written to ongoing medical care to San Franciscans help make this program easy to understand. without health insurance. Healthy Please read it before making your first doctor’s San Francisco offers a limited network appointment. of health care providers. If you use other services or other providers, you will likely What is Healthy San Francisco? get billed. You will get billed if you need Healthy San Francisco is a program designed to emergency care or hospitalization outside of make health care services available and affordable San Francisco or receive emergency care or to uninsured San Francisco residents regardless hospitalization from San Francisco hospitals of immigration status, employment status, or that are not partnered with your Medical pre-existing medical conditions. What makes this Home (unless you are eligible for their program special is that you get to choose a charity care program). Medical Home to go to not only when you’re sick, If you have health insurance, do not but for regular and preventive care to help you drop it. stay healthy. With Healthy San Francisco: Insurance provides you with more choices and options to meet your health care needs. • You can choose your own Medical Home Healthy San Francisco is not insurance. • You will have your own Medical Home doctor or provider who will get to know you and your health history Healthy San Francisco is a program of last resort for San Francisco residents who cannot get health • You have a Medical Home and Customer Service Center to call when you need help insurance. • You know how much your services will cost People who are eligible for full-scope public health before you receive them insurance programs such as Medi-Cal, or • You have an easy way to re-enroll in the financial assistance through Covered California™, program by completing a renewal application are not eligible for Healthy San Francisco. Program once a year rules, including who is eligible, what services • You don’t have to wait until you’re sick are included, the availability of various Medical to get medical care Homes, the cost to participate, and any medical services may change without notice. 1 | Healthy San Francisco www.healthysanfrancisco.org (415) 615-4555 | 2 Your Medical Home Your ID Card Every Healthy San Francisco Participant chooses a Healthy San Francisco Participants are mailed an Medical Home when enrolling and renewing their identification card, called a Participant ID Card, Healthy San Francisco coverage. A Medical Home when they enroll or when they change Medical is the health care facility (in most cases, a clinic) Homes. Your ID card lets your Medical Home where a primary care provider will provide your know that you are enrolled in Healthy medical care. You will access all of your medical San Francisco. Carry this ID Card at all times, services through your Medical Home. It is the but most importantly when: first place you should call when seeking medical • Visiting your Medical Home services. • Accessing medical services of any kind Call Your Medical Home to: • Schedule a medical appointment Participant ID#: XXXXXXXXXXXXX DOB: 06/25/1988 • Ask about refills for prescription medicine Language: English • Get a referral to a specialist PAT LEE • Enroll or renew your Medical Home: Medical Home Name Medical Home Address: Healthy San Francisco coverage* 1234 Main Street Medical Home Phone: (415) 615-4500 Healthy San Francisco is NOT insurance and will not cover any services outside the participant’s Healthy San Francisco network–including The telephone number for your Medical emergency care. This card is for identification only. It does not guarantee eligibility in Home is located on your Healthy San Francisco Healthy San Francisco. Participant ID Card. The current Healthy San Francisco Medical Home Network is comprised of San Francisco Department of Public Health Clinics, San Francisco Your Your Your Participant Name Medical Language ID No. Community Clinic Consortium clinics, private Home physician groups and other providers. Detailed information on clinic locations, contact information, and services can be found in the Above is a sample of what a Healthy San Francisco Medical Home Directory available on our website Participant ID Card looks like. at www.healthysanfrancisco.org. *If you have questions about where to enroll or renew, call Healthy San Francisco at: (415) 615-4555 3 | Healthy San Francisco www.healthysanfrancisco.org (415) 615-4555 | 4 Order a Replacement ID Card Reporting a Complaint If you have lost your Healthy San Francisco If you have a problem with the program or ID Card, call Customer Service to order a services you receive, try talking about it with your replacement. doctor or someone at your Medical Home when Customer Service representatives are available it happens. This may be the best way to resolve Monday through Friday, 8:30am to 5:30pm the problem quickly. If you still haven’t reached a solution, call Healthy San Francisco Customer • Healthy San Francisco Participants: Service for help at: (415) 615-4555 (415) 615-4555 • TDD/TTY for People who are Deaf, Hard-of-Hearing, or have Speech Disabilities: Monday through Friday 8:30am to 5:30pm PST (415) 547-7830 If the problem is still not resolved, you may file a formal complaint by phone through Customer Make an Appointment at Service by completing a complaint form online, or Your Medical Home by sending a written letter to: If you are a current Healthy San Francisco Healthy San Francisco Participant, you may schedule a doctor’s 201 3rd St., 7th Floor appointment by contacting your Medical Home. San Francisco, CA 94103 Your Medical Home address and phone number In your written letter, please provide: are listed on your Participant ID Card. • Your contact information including your Participants must call their Medical Home to name, phone number, and email address so we can follow up with you regarding your cancel or reschedule an appointment with at least complaint 48 hours notice. • The 14-digit ID number on your Please be aware that you may not be able to make Healthy San Francisco ID Card an appointment immediately, so plan ahead when • A description of your complaint you need to access services. Please describe the problem in detail: • What has been done so far to address the problem • Describe what you would like done to do to solve the problem. You will not be dropped from the program for filing a complaint. 5 | Healthy San Francisco www.healthysanfrancisco.org (415) 615-4555 | 6 Health Care Services Provided by Urgent Care Healthy San Francisco It is always best to receive care from your Primary and Preventive Care Medical Home. If you need to see a doctor right away because you are in pain, check with your Treatment of routine medical conditions, Medical Home to see if they can see you in regular check-ups and health screenings are an their clinic. important part of your ongoing health care treatment. All of these services are covered by Urgent Care services are available at the hospital in Healthy San Francisco and are provided by your your Medical Home Network. Healthy Medical Home. San Francisco only covers the cost of services at the hospital in your Medical Home Make appointments directly with your Medical Network. To find the urgent care location for Home for regular check-ups. each Medical Home, see the chart on pages Specialty Care 11-12. Specialists are doctors who see patients with special health care conditions, such as asthma, Ambulance Services diabetes, or heart problems. Your Medical Home Ambulance services
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