Medi-Cal Member Handbook - LA Care Health Plan

Medi-Cal Member Handbook / Benefit Year 2010-2011
Living in a skilled nursing facility (Level
A or B. This includes subacute care
facilities.)
Pregnant (If you are pregnant, you can
continue to receive pregnancy-related
benefits and services. You can also
receive other benefits and services listed
above to treat conditions that, if left
untreated, might cause difficulties for the
pregnancy. This includes dental exams,
cleanings, and gum treatment. Dental and
other benefits and services may also be
available up to 60 days after the baby is
born.)
Receiving benefits through the California
Children’s Services (CCS) program
Receiving benefits through a Program of
All-Inclusive Care for the Elderly
However, L.A. Care feels that five (5) benefits
the state cut are important to our members and
will still provide these benefits when there is a
medical need.
As an L.A. Care Medi-Cal member, you will keep
getting:
Speech therapy services
Podiatry (foot) services
Audiology (hearing) services
Incontinence creams and washes
Annual optometry (eye) exam for diabetic
members
Services you can get outside of your
health plan
Some services are not covered by L.A. Care or
Anthem Blue Cross but are still benefits. They are
available through Medi-Cal or another state
program. Please call L.A. Care or Anthem Blue
Cross if you have any questions about getting the
services below.
Acupuncture (Limited – please see the
“Medi-Cal benefit changes” section)
Adult day health care
Alcohol and drug treatment services
(outpatient)
Childhood lead poisoning (through the
Los Angeles County Department of
Health Services)
Chiropractic services (Limited– please see
the “Medi-Cal benefit changes” section)
Direct Observed Therapy for the treatment
of tuberculosis (through the Los Angeles
County Department of Health Services)
Dental Services (Limited– please see the
“Medi-Cal benefit changes” section) that
are normally done by a dentist,
orthodontist or oral surgeon, and dental
appliances. You must get Dental Services
through Denti-Cal. Call toll-free at
1-800-322-6384 to learn more. Anthem
Blue Cross covers dental screenings under
the first health checkup and will refer
members to Medi-Cal dental providers.
Anthem Blue Cross covers the following
when medically necessary: prescription
drugs, lab services, outpatient surgical
services, and inpatient services. General
anesthesia for dental work is covered for
members under seven (7) years of age, the
developmentally disabled or when
medically necessary.
Early Start/Early Intervention. Early
Start/Early Intervention is for children
ages 0 to 3. If your PCP doctor tells you
that your child is at risk for developmental
delays, your child may be eligible for the
Early Start program. Developmental
delays include difficulties in
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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