Health Lecture Series
Patients and Visitors
As a patient at Lompoc Valley Medical Center, you have the right to:
- Considerate and respectful care, and to be made comfortable. You have the right to respect for your cultural, psychosocial, spiritual, and personal values, beliefs and preferences.
- Have a family member (or other representative of your choosing) and your own physician notified promptly of your admission to the hospital.
- Know the name of the physician who has primary responsibility for coordinating your care and the names and professional relationships of other physicians and non-physicians who will see you.
- Receive information about your health status, diagnosis, prognosis, course of treatment, prospects for recovery and outcomes of care (including unanticipated outcomes) in terms you can understand. You have the right to effective communication and to participate in the development and implementation of your plan of care. You have the right to participate in ethical questions that arise in the course of your care, including issues of conflict resolution, withholding resuscitative services, and forgoing or withdrawing life-sustaining treatment.
- Make decisions regarding medical care, and receive as much information about any proposed treatment or procedure as you may need in order to give informed consent or to refuse a course of treatment. Except in emergencies, this information shall include a description of the procedure or treatment, the medically significant risks involved, alternate courses of treatment or non-treatment and the risks involved in each, and the name of the person who will carry out the procedure or treatment.
- Request or refuse treatment, to the extent permitted by law. However, you do not have the right to demand inappropriate or medically unnecessary treatment or services. You have the right to leave the hospital even against the advice of physicians, to the extent permitted by law.
- Be advised if the hospital/personal physician proposes to engage in or perform human experimentation affecting your care or treatment. You have the right to refuse to participate in such research projects.
- Reasonable responses to any reasonable requests made for service.
- Appropriate assessment and management of your pain, information about pain, pain relief measures and to participate in pain management decisions. You may request or reject the use of any or all modalities to relieve pain, including opiate medication, if you suffer from severe chronic intractable pain. The doctor may refuse to prescribe the opiate medication, but if so, must inform you that there are physicians who specialize in the treatment of severe chronic pain with methods that include the use of opiates.
- Formulate advance directives. This includes designating a decision maker if you become incapable of understanding a proposed treatment or become unable to communicate your wishes regarding care. Hospital staff and practitioners who provide care in the hospital shall comply with these directives. All patients' rights apply to the person who has legal responsibility to make decisions regarding medical care on your behalf.
- Have personal privacy respected. Case discussion, consultation, examination and treatment are confidential and should be conducted discreetly. You have the right to be told the reason for the presence of any individual. You have the right to have visitors leave prior to an examination and when treatment issues are being discussed. Privacy curtains will be used in semi-private rooms.
- Confidential treatment of all communications and records pertaining to your care and stay in the hospital. You will receive a separate "Notice of Privacy Practices" that explains your privacy rights in detail and how we may use and disclose your protected health information.
- Receive care in a safe setting, free from mental, physical, sexual or verbal abuse and neglect, exploitation or harassment. You have the right to access protective and advocacy services including notifying government agencies of neglect or abuse.
- Be free from restraints and seclusion of any form used as a means of coercion, discipline, convenience or retaliation by staff.
- Reasonable continuity of care and to know in advance the time and location of appointments as well as the identity of the persons providing the care.
- Be informed by the physician, or a delegate of the physician, of continuing health care requirements and options following discharge from the hospital. You have the right to be involved in the development and implementation of your discharge plan. Upon your request, a friend or family member may be provided this information also.
- Know which hospital rules and policies apply to your conduct while a patient.
- Designate visitors of your choosing, if you have decision-making capacity, whether or not the visitor is related by blood or marriage, unless:
- No visitors are allowed.
- The facility reasonably determines that the presence of a particular visitor would endanger the health or safety of a patient, a member of the health facility staff or other visitor to the health facility, or would significantly disrupt the operations of the facility.
- You have told the health facility staff that you no longer want a particular person to visit.
- However, a health facility may establish reasonable restrictions upon visitation, including restrictions upon the hours of visitation and number of visitors.
- Have your wishes considered, if you lack decision-making capacity, for the purposes of determining who may visit. The method of that consideration will be disclosed in the hospital policy on visitation. At a minimum, the hospital shall include any persons living in your household.
- Examine and receive an explanation of the hospital's bill regardless of the source of payment.
- Exercise these rights without regard to sex, race, color, religion, ancestry, national origin, age, disability, medical condition, marital status, sexual orientation, educational background, economic status or the source of payment for care.
- File a grievance. If you want to file a grievance with this hospital, you may do so by writing or by calling Quality Improvement Department, P.O. Box 1058 , Lompoc , CA 93438 , 705-737-5723 or 805-737-3358.
The grievance committee will review each grievance and provide you with a written response within 30 days. The written response will contain the name of a person to contact at the hospital, the steps taken to investigate the grievance, the results of the grievance process, and the date of completion of the grievance process. Concerns regarding quality of care or premature discharge will also be referred to the appropriate Utilization and Quality Control Peer Review Organization (PRO).
If you wish to file a grievance with this hospital
Quality Improvement Department
P.O. Box 1058
Lompoc , CA 93438
805-737-5723 or 805-737-3358
You also have the right to file a complaint with the following agencies:
The California Department of Public Health
For general concerns about your quality of care.
(916) 588-1784 or www.cdpha.ca.gov
Health Services Advisory Group (formerly Lumetra) our PRO
For concerns about premature discharge or quality of care.
1-866-800-8750 or www.hsag.com
For concerns about physician care.
1-800-633-2322 or www.medbd.ca.gov
The Joint Commission
For complaints that are not being resolved.
Office of Quality Monitoring
The Joint Commission
One Renaissance Boulevard
Oakbrook Terrace, IL 60181
(800) 994-6610 or wwwjointcommission.org
This Patient Rights document incorporates the requirements of the Joint Commission; Title 22, California Code of Regulations, Section 70707; Health and Safety Code Sections 1262.6, 1288.4, and 124960; and 42 C.F.R. Section 482.13 (Medicare Conditions of Participation).
Our goal is to provide a professional healing environment. Each patient is allowed a maximum of two (2) visitors. If others would like to visit, please take turns. Please do not visit if you have a fever, a cold, a sore throat, the flu, or recently have been exposed to, but never had, chicken pox, measles, or mumps. This is a protection of your loved one and others who are hospitalized.
Visitors are welcome between:
10:00 AM – 2:00 PM and from 4:00 PM – 8:00 PM daily.
Please help us maintain the healing environment by refraining from loud noises or voices.
All visitors must check in upon arriving, at which point, each visitor will receive a badge. All visitors MUST have a badge, no exceptions.
Parents and grandparents may visit at any time. We encourage one parent to be with the child at all times. Healthy siblings may visit but please limit their visit to 30 minutes or less.
Labor and Delivery
The father or significant other may stay and visit at any time. Other visitors are welcome, but only two (2) at a time, please.
Visitors are welcome. The length of the visit may be adjusted by the nurse caring for the patient. The rooms are small and visitors are limited to two (2) at a time. There is a visitor restriction when shifts change. Those times are 6am to 7am and 6pm to 7pm. There is a waiting room and garden across from CCU for your use.
Family members waiting for Surgery patients may wait in the Surgery Waiting Room. Please let the nurse know who you are so we can notify you when the surgery is complete and the surgeon can talk to you when.
Patient Rules & Responsibilities
As a patient at the Lompoc Valley Medical Center, you have the following responsibilities:
An effort to help you understand your hospital bill and address questions frequently raised by our patients. It is our intent to provide you with an accurate and understandable bill for the hospital services.
Please call our business office at 737-3300 if we can assist you.
- Why are there so many bills?
- What will my insurance plan pay?
- What payment does the hospital receive?
- What do I do if I continue to receive computerized statements requesting that I pay my bill?
- How does my health plan calculate what I owe?
The hospital will bill the patient, the patient's insurance or health plan for non-physician services that are provided at the hospital. Services provided by the physician are billed separately by the physician's billing agent. Especially after a visit to the ER, Radiology, or after receiving Lab Work, you may receive a separate bill for some services. This bill cannot be paid at the hospital and in most cases must be mailed. [ Back to Top ]
If you have current coverage through an insurance or health plan, our Billing Department will gladly bill them and any secondary or supplemental plan you may have. Within a reasonable time period (Usually 30-45 days) you should receive an "Explanation of Benefits" from your insurance company, referred to as an EOB. This form should show you what your plan will pay and if you owe any deductible or co-payment. With some plans, including Medicare, you may have a supplemental plan that will pay your yearly deductible or co-payment. We strongly suggest that you become familiar with your insurance plan and know what covered benefits you have, including whether a pre-authorization is required . Your insurance agent also can be of great help regarding questions about your coverage. [ Back to Top ]
There are three basic reasons why you may get a bill:
Your insurance has been billed but has delayed payment
Your insurance has denied payment
The amount billed is what you are responsible for paying
Please call our Business Office to see if we have received any response from your insurance company or health plan. If your insurance has requested additional information from you so that they can process your claim, it is important that you respond promptly to their request. If your insurance company is delaying payment, your call to them directly can be effective since you are their subscriber and should be considered their valued customer. [ Back to Top ]
In many cases, the amount you owe is determined by the health plan policy rather than the hospital charges. An example of this is as follows: Hospital Charges $10,000 Plan's Discounted Rate -4,900 Amount paid by plan $4,410 Amount to be Paid by Patient (10% Deductible) $490 Total Paid to Hospital $4,900 Unpaid Hospital Charges or Revenue $5,100 Based on the health plan policy, the $490 that you owe is based on 10% of the contracted amount and not the hospital charges. [ Back to Top ]
One of the least understood facts is that about 85% of hospital bills are paid by an insurance company or Health Plan that disregards the actual hospital charges, as mentioned previously. Most of these payers have pre-arranged discounted prices which they have determined or, in some instances, have negotiated in a contract with the hospital As in the example, the average amount that these payers are actually paying the hospital is about 49 cents for every dollar billed. In the example, the hospital received $4,410 from the insurance company and $490 from the patient. The $5,100 is what the hospital must absorb and cannot bill either the patient or the secondary insurance. This is the case for 85% of our patients, including Medicare, Medi-Cal, and most preferred provider health plans and HMO's. [ Back to Top ]
The following is a glossary of terms often used at the hospital in the admitting and billing office:
INPATIENT: A patient that has a specific diagnosis and is admitted at least overnight.
OBSERVATION PATIENT: A patient that is admitted for observation and testing prior to determining the specific diagnosis and treatment. An observation patient may stay in the hospital overnight or several days before being discharged or admitted as an inpatient.
OUTPATIENT: A patient that is admitted to the Emergency Department or for Outpatient Surgery or other tests that do not require the patient to stay overnight. On occasion, an outpatient may stay overnight and be discharged the following morning without changing their patient status.
PRE-AUTHORIZATION: Most insurance companies or health plans require the patient or healthcare provider to seek approval before having expensive treatment or tests carried out.
This pre-approval or pre-authorization usually gives both the patient and the provider the assurance that the service will be paid for by the insurance company or health plan. If a patient is not given pre-authorization, the provider will still perform the test or treatment; however, the patient is the financially responsible for the medical bill.
DEDUCTIBLE: A yearly amount usually owed by the patient or family before other health benefits are paid by the insurance company or health plan. CO-PAYMENT: This is often a set fee which the insurance company or health plan requires the patient to pay each time a specific health care service is provided, such as a doctor's visit or an emergency room visit.
MANAGED CARE: this term applies to healthcare coverage in which the patient is required to be seen by a primary care physician who authorizes or "manages" all health care for the patient in order for the healthcare services to be paid for by the health plan. This could be either an HMO or a Preferred Provider Plan. [ Back to Top ]
Important Medical Questions
This document explains your right to make healthcare decisions and how you can plan now for your medical care if you are unable to speak for yourself in the future
Who decides about my treatment?
Your doctors will give your information and advice about treatment. You have the right to choose. You can say Yes to treatments you want. You can say No to any treatments that you don't want even if the treatment might keep you alive longer.
How do I know what I want?
Your doctor must tell you about your medical condition and about what different treatments and pain management alternatives can do for you. Many treatments have side effects. Your doctors must offer you information about problems that medical treatment is likely to cause you Often, more than one treatment might help you-and people have different ideas about which is best.
Your doctor can tell you which treatments are available to you, but your doctor can't choose for you. That choice is yours to make and depends on what is important to you.
Can other people help with my decisions?
Yes. Patients often turn to their relatives and close friends for help in making medical decisions. These people can help you think about the choices you face. You can ask the doctors and nurses to talk with your relatives and friends. They can ask the doctors and nurses questions for you.
Can I choose a relative or friend to make healthcare decisions for me?
Yes. You may tell your doctor that you want someone else to make healthcare decisions for you. Ask the doctor to list that person as your healthcare surrogate in your medical records. The surrogate's control over your medical decisions is effective only during treatment for your current illness or injury or, if you are in a medical facility, until you leave the facility
What if I become too sick to make my own healthcare decisions?
If you haven't named a surrogate, your doctor will ask your closest available relative or friend to help decide what is best for you. Most of the time that works, but sometimes everyone doesn't agree about what to do. That's why it I s helpful if you can say in advance what you want to happen if you can't speak for yourself.
Do I have to wait until I am sick to express my wishes about health care?
No, in fact it is better to choose before you get very sick or have to go into a hospital, nursing home, or other healthcare facility. You can use an Advance Healthcare Directive to say who you want to speak for you and what kind of treatments you want.
These documents are called advance because you prepare one before healthcare decisions need to be made. They are called directives because they state who will speak on your behalf and what should be done. In California, the part of an advance directive you can use to appoint an agent and make healthcare decisions is called a Power of Attorney for Health Care The part where you can express what you want done is called an Individual Health Care Instruction
Who can make an advance directive?
You can if you are 18 years or older and are capable of making your own medical decisions. You do not need a lawyer.
Who can I name as my agent?
You can choose an adult relative or any other person you trust to speak for you when medical decisions must be made.
When does my agent begin making my medical decisions?
Usually, a healthcare agent will make decisions only after you lose the ability to make them yourself, but if you wish, you can state in the Power of Attorney for Health Care that you want the agent to begin making decisions immediately
How does my agent know what I would want?
After you choose your agent, talk to that person about what you want. Sometimes treatment decisions are hard to make, and it truly helps if your agent knows what you want. You can also write your wishes down in your advance directive.
What if I don't want to name an agent?
You can still write out your wishes in your advance directive without naming an agent. You can say that you want to have your life continued as long as possible, or you can say that you would not want treatment to continue your life. Also, you can express your wishes about the use of pain relief or any other type of medical treatment.
Even if you have not filled out a written Individual Health Care Instruction, you can discuss your wishes with your doctor, and ask your doctor to list those wishes in your medical record. Or, you can discuss your wishes with your family members or friends, but it will probably be easier to follow your wishes if you write them down.
What if I change my mind?
You can change or cancel your advance directive at any time as long as you can communicate your wishes. To change the person you want to make your healthcare decisions, you must sign a statement or tell the doctor in charge of your care
What happens when someone else makes decisions about my treatment?
The same rules apply to anyone who makes healthcare decisions on your behalf - a healthcare agent, a surrogate whose name you gave to your doctor, or a person appointed by a court to make decisions for you. All are required to follow your Health Care Instructions or, if none, your general wishes about treatment, including stopping treatment. If your treatment wishes are not none, the surrogate must try to determine what is in your best wishes.
The people providing your health care must follow the decisions of your agent or surrogate unless a requested treatment would be bad medical practice or ineffective in helping you. If this causes disagreement that cannot be worked out, the provider must make a reasonable effort to find another healthcare provider to take over your treatment.
Will I still be treated if I don't make an advance directive?
Absolutely. You will still get medical treatment. We just want you to know that if you become too sick to make decisions, someone else will have to make them for you. Remember that: A Power of Attorney for Health Care lets you name an agent to make decisions for you. Your agent can make most medical decisions - not just those about life sustaining treatment - when you can't speak for yourself.
You can also let your agent make decisions earlier, if you wish. You can create an Individual Healthcare Instruction by writing down your wishes about health care or by talking with your doctor and asking the doctor to record your wishes in your medical file.
If you know when you would or would not want certain types of treatment, an Instruction provides a good way to make your wishes clear to your doctor and to anyone else who may be involved in deciding about treatment on your behalf. These two types of Advance Healthcare Directives may be used together or separately.
How can I get more information about making an advance directive?
Ask your doctor, nurse, social worker, or healthcare provider to get more information for you. You can have a lawyer write an advance directive for you or you can complete an advance directive by filling in the blanks on a form.