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

Medi-Cal Member Handbook / Benefit Year 2006-2007More important information:What else do I need to know?If you travel outside of Los AngelesCountyAs a member of L.A. Care and CommunityHealth Plan, your service area is Los AngelesCounty. All locations outside of Los AngelesCounty are out of your service area.Routine care is not covered out of service area.Emergency and urgent care services are coveredoutside of Los Angeles County.How a provider gets paidHealth care providers can be paid several ways:• A fee for each service provided• Capitation (a flat rate paid each month permember)• Provider incentives or bonusesPlease call Community Health Plan if you wouldlike to know more about how your doctor is paidor about financial incentives or bonuses.If you have other insurancePlease call Community Health Plan at 1-800-475-5550 to tell us about any health insurance youhave other than L.A. Care/Community HealthPlan. We will send all bills to the correct place forpayment.Workers' CompensationL.A. Care/Community Health Plan will not payfor work related injuries covered by Workers’Compensation. Community Health Plan willprovide health care services you need while thereare questions about an injury being work related.Before Community Health Plan will do this, youmust agree to give Community Health Plan allinformation and documents needed to recovercosts for any services provided.Third party liabilityCommunity Health Plan will provide coveredservices where an injury or illness is caused by athird party. Community Health Plan may requestthe legal right to keep any payment or right topayment you may have received as a result of athird party injury or illness. Under CaliforniaState Law, this is called “asserting a lien.” Theamount of this lien may include:• Reasonable and true costs paid for health careservices given to you• An additional amount as provided underCalifornia State LawAs a member, you also agree to help CommunityHealth Plan in recovering payments for servicesprovided. This may require you to sign or providedocuments needed to protect the rights ofCommunity Health Plan.Disruption in servicesL.A. Care will use its best efforts to provideservices in the event of a war, riot, or otherunusual event. If L.A. Care/Community HealthPlan is not able to provide health services, wewill send members to the nearest hospital foremergency services and pay for these services.Organ donationThere is a need for organ donors in the UnitedStates. You can agree to donate your organs inthe event of your death. The California Departmentof Motor Vehicles (DMV) will give you adonor card if you wish to become an organ or41Community 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