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

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Medi-Cal Member Handbook / Benefit Year 2006-2007programs are free. Health education services helpmembers by:• Promoting health• Preventing diseases• Helping manage chronic diseases (such asasthma, heart disease and diabetes)• Providing information on tobacco, alcohol anddrug abuseHealth education services are delivered through:• Literature (booklets)• Tapes• Classes• Counseling (one-to-one learning or counseling)• Support groups• Diabetic self-management education programsthat include nutrition and counseling.Ask your doctor for health education materialsand classes. You can also call Community HealthPlan.Hearing Aids• Hearing aids are covered when ordered byyour doctor.HIV TestingYou can get confidential HIV testing from anyhealth care provider licensed to provide theseservices. You do not need a referral or okay fromyour PCP doctor or health plan for confidentialHIV testing. Examples of where you can getconfidential HIV testing include:• Your PCP doctor• Los Angeles County Department of HealthServices• Family planning services providers• Prenatal clinicsPlease call Community Health Plan to request alist of testing sites.Home HealthThese services are provided in the home by healthcare personnel for all of the following:• Short-term physical, occupational and speechtherapy• Respiratory therapy when prescribed by alicensed practitioner acting within the scope ofhis or her licensure.Home health services ordered by your doctor areprovided by home health personnel such as:• Registered Nurses (RNs)• Licensed Vocational Nurses (LVNs)• Home Health Aides• Medical Social ServicesIf a service can be provided in more than onelocation, Community Health Plan will work withthe provider to choose the location.Hospice CareCare is limited to terminally ill members expectedto live 12 months or less. If you decide to receivehospice benefits, you are waiving all rights to allother benefits for the terminal illness for theduration of the hospice election.Hospital CareIncludes, but is not limited to:• Inpatient services• Intensive care• Outpatient services15Community 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
Medi-Cal Member Handbook / Benefit Year 2006-2007Lab Services• Blood work• Urine tests• Throat culturesServices must be provided at a network:• Doctor’s office• Hospital• LaboratoryMastectomy• Mastectomy is a surgery to remove a breast,due to cancer.• Mastectomy• Prosthesis• Reconstructive surgery. See the “ReconstructiveSurgery” in this section for more.You and your doctor decide how long you need tostay in the hospital after the surgery based onmedical necessity.Maternity CareMaternity care includes:• Regular doctor visits during your pregnancy(called “prenatal” visits)• Diagnostic and genetic testing• Nutrition counseling• Labor and delivery care• Health care six weeks after delivery (called“postpartum” care)• Inpatient hospital care for at least 48 hoursafter a normal vaginal deliveries, or for atleast 96 hours after a cesarean section.Coverage for inpatient hospital care may beless than 48 hours or 96 hours if:o The decision is made by the mother andtreating physician, ando A post-discharge follow up visit for themother and newborn is made within 48hours of discharge.If you are pregnant, call Community HealthPlan at 1-800-475-5550 right away. We want tomake sure you get the care you need.Community Health Plan will help you chooseyour maternity care doctor from a doctor in yournetwork. Ask your doctor to find out more.After giving birth, you will receive breastfeedingeducation and special equipment if needed. Askyour doctor, or call Community Health Plan ifyou have any questions.Go to “Women, Infants and Children (WIC)Program” under “More Benefits: What otherservices can I get?” for information about nutritionand food stamps.Minor Consent ServicesThere are some services adolescent members(children ages 12 to 18) can get without a parent’sokay. Minors may choose to get these servicesthrough their PCP doctor or from other qualifiedproviders not with Community Health Plan’snetwork.The following services are covered:• Counseling and surgical procedures to endpregnancy (abortion)• Drug and alcohol abuse services• Family planning services• Outpatient mental health treatment and counseling• Pregnancy related services• Sexual assault services• Sexually transmitted disease (STD) services16Community 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
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