Medi-Cal Member Handbook - LA Care Health Plan

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HIV testing. Examples of where you can get confidential HIV testing include: Your PCP doctor Los Angeles County Department of Health Services Family planning services providers Prenatal clinics Please call Anthem Blue Cross to request a list of testing sites. Home health These services are provided in the home by health care personnel for all of the following: Short-term physical, occupational, and speech therapy Medi-Cal Member Handbook / Benefit Year 2010-2011 Respiratory therapy when prescribed by a licensed practitioner acting within the scope of his or her license Home health services ordered by your doctor are provided by home health personnel such as: Registered Nurses (RNs) Licensed Vocational Nurses (LVNs) Home Health Aides Medical Social Services If a service can be provided in more than one location, Anthem Blue Cross will work with the provider to choose the location. Hospice care Care is limited to terminally ill members expected to live 12 months or less. If you decide to receive hospice benefits, you are waiving all rights to all other benefits for the terminal illness for the duration of the hospice election. The hospice election may be made of up to two (2) periods of 90 days each, one subsequent period of 30 days, and one 180-day extension of the 30-day period. Hospice services are not covered for more than 390 days. Hospital care Includes, but is not limited to: Inpatient services Intensive care Outpatient services Incontinent creams and washes These are provided at no cost when there is a medical need. Lab services Blood work Urine tests Throat cultures Services must be provided at a network: Doctor’s office Hospital Laboratory Mastectomy Mastectomy is a surgery to remove a breast, due to cancer. Prosthesis (replacing a missing body part with an artificial one) Reconstructive surgery (see “Reconstructive Surgery” in this section for more information) You and your doctor decide how long you need to stay in the hospital after the surgery based on medical necessity. 18 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
Maternity care Maternity care includes: Regular doctor visits during your pregnancy (called prenatal visits) Diagnostic and genetic testing Nutrition counseling Labor and delivery care Health care six (6) weeks after delivery (called postpartum care) Medi-Cal Member Handbook / Benefit Year 2010-2011 Inpatient hospital care for at least 48 hours after normal vaginal deliveries or for at least 96 hours after a Cesarean section. Coverage for inpatient hospital care may be less than 48 hours or 96 hours if: o The decision is made by the mother and treating physician, and o A post-discharge follow-up visit for the mother and newborn is made within 48 hours of discharge. If you are pregnant, call Anthem Blue Cross at 1-888-285-7801 right away. We want to make sure you get the care you need. Anthem Blue Cross will help you choose your maternity care doctor from a doctor in your network. Ask your doctor to find out more. After giving birth, you will receive breastfeeding education and special equipment if needed. Ask your doctor, or call Anthem Blue Cross if you have any questions. Go to “Women, Infants and Children (WIC) Program” under the “More benefits: What other services can I get?” section of this handbook for information about nutrition and food stamps. Minor consent services There are some services adolescent members (12 to 21 years of age) can get without a parent’s okay. Minors can decide to get these services through their PCP doctor or from other qualified providers not with Anthem Blue Cross’ network. The following services are covered: Counseling and surgical procedures to end pregnancy (abortion) Drug and alcohol abuse services for members 12 years of age or older Family planning Pregnancy related services Sexual assault treatment (including rape) Sexually transmitted disease (STD) services for members 12 years of age or older Outpatient mental health treatment and counseling for minors (12 to 21 years of age) who are mature enough to participate, and where either: o There is danger of serious physical or mental harm to themselves or to others; or o They are a victim of incest or child abuse. Newborn care Your newborn baby will be covered by Anthem Blue Cross for the month of birth and the following month. When you have a baby, it is important to do three (3) things: 1. Please call L.A. Care at 1-888-839-9909. We want to make sure you and your baby get the care you need right away. 2. Contact your eligibility worker at DPSS toll-free at 1-877-481-1044 to enroll your 19 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
Page 1: Medi-Cal Member Handbook Benefit Ye
Page 5: Dear Member: Welcome to your health
Page 8 and 9: Get Answers from 24/7 NurseLine •
Page 11 and 12: As an L.A. Care/Anthem Blue Cross m
Page 13 and 14: Benefit Year 2010-2011 Medi-Cal Mem
Page 15 and 16: Medi-Cal Member Handbook / Benefit
Page 19 and 20: WELCOME: Thank you for choosing L.A
Page 21 and 22: This Member Handbook: Why is it imp
Page 23 and 24: Let’s get started: How do I get h
Page 25 and 26: time they found out about your Medi
Page 27 and 28: ID Cards: How do I use them? What t
Page 31 and 32: How to keep seeing your doctor if y
Page 35: Anthem Blue Cross’ network. You d
Page 39 and 40: You can get confidential STD servic
Page 41 and 42: More benefits: What other services
Page 45 and 46: Pharmacy benefits: How do I get pre
Page 47 and 48: Your doctor Medi-Cal Member Handboo
Page 49 and 50: What to do in an emergency Call 911
Page 51 and 52: state and local government services
Page 53 and 54: You can also file a grievance onlin
Page 55 and 56: You must first go through the Anthe
Page 59 and 60: Before L.A. Care or Anthem Blue Cro
Page 61 and 62: Medi-Cal: How can I make sure I don
Page 63 and 64: If you are disenrolled from L.A. Ca
Page 65 and 66: More important information: What el
Page 67 and 68: Glossary of Terms This glossary wil
Page 69 and 70: Food and Drug Administration (FDA)
Page 71 and 72: Out-of-area services are emergency
Page 73 and 74: Important Phone Numbers Medi-Cal Ha
Page 75: Other Things to Know About Your Hea
Page 79: If you are pregnant, call us right
Page 82 and 83: 24/7 NurseLine Mensajes Grabados En
Page 84 and 85: 1907 Heart Failure 1908 Atrial Fibr
Page 86 and 87:
2164 Laparoscopy 2165 Ear Tubes 217
Page 88 and 89:
Guidelines for Healthy Children and
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Guidelines for Pregnant Women The c
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Guidelines for Healthy Adults Adult
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These guidelines may have changed s
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HOW WE MAY USE AND SHARE INFORMATIO
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• You and your personal represent
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Or Secretary of the U.S. Department
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BUSINESS REPLY MAIL FIRST-CLASS MAI
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Medi-Cal Member Handbook - LA Care Health Plan

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