Medi-Cal Member Handbook - LA Care Health Plan

What is covered: What kinds
of health care can I get from
Anthem Blue Cross?
In order for you to get any health care service
through Anthem Blue Cross, the service must be
both:
A covered benefit in Medi-Cal; and
Medically necessary.
A “covered benefit” means that you can get this
service through Medi-Cal and Anthem Blue
Cross. “Medically necessary” means that you
need the service to get healthy or stay healthy.
All health care services are reviewed, modified
(changed), approved or denied according to
medical necessity. If you would like a copy of the
policies and procedures Anthem Blue Cross uses
to decide if a service is medically necessary, call
Anthem Blue Cross. No doctor has to give you
services that he/she doesn’t believe you need.
Services are subject to all terms, conditions,
limits and exclusions. You can learn more about
this in the “Non-covered Services: What does
Medi-Cal not cover?” section of this handbook.
All services require prior authorization unless
the benefit says that it does not require prior
authorization. “Prior authorization” means that
your PCP doctor and Anthem Blue Cross agree
that services and care are necessary. You must
have a prior authorization before you get services
or care, such as services from a specialist.
Services that do not require prior authorization
are:
Medi-Cal Member Handbook / Benefit Year 2010-2011
PCP doctor visits
Emergency services
Urgently needed services when outside of
Los Angeles County
Family planning services
Preventive services
Sexually transmitted disease (STD)
services
HIV testing
Basic prenatal care from a doctor who
works with Anthem Blue Cross
In-network Certified Nurse Midwife/
OB/GYN
Call Anthem Blue Cross at 1-888-285-7801 if
you have questions about:
Your benefits
How or where to get benefits
What is covered or not covered
All covered benefits are free.
Covered benefits:
Alcohol/drug abuse
Crisis intervention
Health education services
Asthma services
Nebulizers (including face mask and
tubing), inhaler spacers and peak flow
meters for management and treatment of
asthma
Member education on proper use of
nebulizers, inhaler spacers and peak flow
meters for asthma
Cancer screening
All generally medically accepted cancer
screening tests, including coverage for
screening and diagnosis of prostate cancer
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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