Medi-Cal Member Handbook - LA Care Health Plan

Our provider network: Who
gives me health care?
Please read the following information so you will
know from whom or what group of providers you
can get health care.
Anthem Blue Cross works with a large group of
doctors, specialists, pharmacies, hospitals and
other health care providers. This group is called a
“network.” You can get a copy of Anthem Blue
Cross’ network by calling Anthem Blue Cross
and asking for a provider directory.
In most cases, you need to get care within
Anthem Blue Cross’ network. That is not the
case if you need emergency care or need urgent
care outside of Los Angeles County. You can
learn more about this in the “Emergency care:
How do I get care in an emergency?” section of
this handbook.
Your PCP doctor gives you most of your care
Your PCP doctor is responsible for making sure
you get the health care benefits you need and
should receive from Medi-Cal.
How to change your PCP doctor
If you didn’t choose a PCP doctor when you
enrolled in Medi-Cal, a PCP doctor was chosen
for you by L.A. Care. Your PCP doctor was
chosen for you based on:
The language you speak
Your age
Medi-Cal Member Handbook / Benefit Year 2010-2011
How close you live to the PCP doctor’s
office
It is best to stay with the same PCP doctor. Your
PCP doctor gets to know your health history and
health needs. If you can’t stay with the same PCP
10
doctor, you can choose a new one from the
Anthem Blue Cross network shown in the
provider directory mailed to you with this
handbook. Call Anthem Blue Cross for another
copy of the provider directory or to help you
choose another PCP doctor.
You can change your PCP doctor for any
reason if you are not happy. To change your
PCP doctor, call Anthem Blue Cross. You may
choose a PCP doctor within the first 30
calendar days of enrollment and change at
least monthly after that.
Things to remember if you choose a new PCP
doctor:
Some doctors work within a group of
doctors with certain specialists, hospitals
and other health care providers. If you
need a specialist, your PCP doctor may
send you to these providers. If you are
going to a specialist already or want to
use a specific hospital, talk with the PCP
doctor you are choosing.
A PCP is a doctor or even a clinic. You
can pick one PCP doctor for all members
of your family in Medi-Cal or you can
pick a different PCP doctor for each
member of your family in Medi-Cal.
Women may choose an OB/GYN or
family planning clinic as their PCP
doctor.
Ask about office access if you or a
family member has a disability.
The PCP doctor you choose may not agree to
treat you and may ask L.A. Care to make a
change. This can happen if:
You are disruptive or disrespectful to
your doctor or your doctor’s office staff.
You do not follow your doctor’s
treatment plan.
Anthem Blue Cross Customer Care Center toll-free 1-888-285-7801
L.A. Care Health Plan Member Services Department toll-free 1-888-839-9909