Member Handbook - Los Angeles County Department of Health ...

Medi-Cal Member Handbook / Benefit Year 2006-2007What is Covered: What kindsof health care can I get fromCommunity Health Plan?In order for you to get any health care servicethrough Community Health Plan, the service mustbe both:• A covered benefit in Medi-Cal and• Medically necessaryA “covered benefit” means that you can get thisservice through Medi-Cal and Community HealthPlan. “Medically necessary” means that you needthe service so you can get healthy or stay healthy.• Family planning services• Preventive service• Basic prenatal care• Sexually transmitted disease services• HIV testingCall Community Health Plan at 1-800-475-5550 if you have questions about:• Your benefits• How or where to get benefits• What is covered or not covered.All health care services are reviewed, modified(changed), approved or denied according tomedical necessity. If you would like a copy of thepolicies and procedures Community Health Planuses to decide if a service is medically necessary,call Community Health Plan. No doctor has togive you services that the doctor doesn’t believeyou need. Services are subject to all terms,conditions, limits and exclusions. These aretalked about in the section, “Non-CoveredServices: What does Medi-Cal not cover?” inthis handbook.All services require prior authorization unlessthe benefit says that it does not require priorauthorization. “Prior authorization” means thatyour PCP doctor and Community Health Planagree that services and care are necessary. Priorauthorization must happen before you get theservices or care.Services that do not require prior authorizationare:• Emergency services• Urgently needed services when outside of LosAngeles CountyAll covered benefits are free.These benefits are coveredAlcohol/Drug Abuse• Crisis intervention• Health education servicesAsthma Services• Nebulizers (including face mask and tubing),inhaler spacers and peak flow meters for managementand treatment asthma• Member education on proper use of nebulizers,inhaler spacers and peak flow meters forasthmaCancer Screening• All generally medically accepted cancerscreening tests, including coverage for screeningand diagnosis of prostate cancer• Mammography for breast cancer screening12Community Health Plan Member Services Department toll-free 1-800-475-5550L.A. Care Health Plan Member Services Department toll-free 1-888-4LA-Care or 1-888-452-2273