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

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Medi-Cal Member Handbook / Benefit Year 2006-2007Table of ContentsThis Member Handbook: Why is it important to you? .................................................................1Whom do I call and when?...................................................................................................................................... 1Helpful information at www.lacare.org on the Internet............................................................................................. 2WELCOME: Now that you are with L.A. Care Health Plan!.........................................................3Your Health Plan Choices with L.A. Care................................................................................................................ 3How to Change Health Plans .................................................................................................................................. 3ID Cards: How do I use them?......................................................................................................4What to do with your L.A. Care/Community Health Plan ID card ............................................................................ 4What to do with your Medi-Cal card (also known as BIC card) ............................................................................... 4Let’s get started: How do I get health care?................................................................................5Your PCP doctor ..................................................................................................................................................... 5Start getting your care now! Call your PCP doctor for a check-up. ........................................................................ 5How to see your PCP doctor................................................................................................................................... 6If you get a bill......................................................................................................................................................... 6What is a second opinion? ...................................................................................................................................... 6How to get a second opinion................................................................................................................................... 6Are you pregnant? Call Community Health Plan at 1-800-475-5550...................................................................... 7How to get health care that your PCP doctor can’t give you ................................................................................... 7How to get a standing referral with a specialist ....................................................................................................... 7Our Provider Network: Who gives me health care?....................................................................8Your PCP doctor gives you most of your care......................................................................................................... 8How to change your PCP doctor............................................................................................................................. 8Kinds of PCP doctors .............................................................................................................................................. 9Picking a Federally Qualified Health Center (FQHC) as your PCP doctor .............................................................. 9How to get care from a specialist ............................................................................................................................ 9Our doctor’s professional qualifications................................................................................................................... 9Certified Nurse Midwives......................................................................................................................................... 9What care can you get from a provider who is not your PCP doctor? ................................................................... 10How to keep seeing your doctor if your doctor leaves your health plan................................................................. 10How to keep seeing your doctor if you are a new member.................................................................................... 10What is Covered: What kinds of health care can I get from Community Health Plan? ...........12iCommunity 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 2006-2007These benefits are covered................................................................................................................................... 12More Benefits: What other services can I get? .........................................................................19California Children’s Services (CCS)..................................................................................................................... 19Child Health and Disability Prevention (CHDP)..................................................................................................... 19Women, Infants and Children (WIC) Program....................................................................................................... 19Special services for Native American Indians ....................................................................................................... 19Services you can get outside of your health plan.................................................................................................. 19Non-Covered Services: What does Medi-Cal not cover? .........................................................21Pharmacy Benefits: How do I get prescription drugs? .............................................................22What is a pharmacy? ............................................................................................................................................ 22How to get a prescription filled .............................................................................................................................. 22What is a formulary? ............................................................................................................................................. 22Drugs not on the formulary.................................................................................................................................... 22What drugs are covered?...................................................................................................................................... 23What drugs are not covered?................................................................................................................................ 23Emergency contraception...................................................................................................................................... 23Medicare Part D: Prescription drug coverage for beneficiaries who get both Medicare and Medi-Cal ................. 24Emergency Care: How do I get care in an emergency? ............................................................25How to get urgent care.......................................................................................................................................... 25What is emergency care?...................................................................................................................................... 25What to do in an emergency ................................................................................................................................. 25Outside of Los Angeles County?........................................................................................................................... 26What to do after an emergency............................................................................................................................. 26How to get emergency transportation ................................................................................................................... 26Not sure you have an emergency? ....................................................................................................................... 26Help in Another Language and for the Disabled: How can I get help? ................................................................. 27Information in other languages.............................................................................................................................. 27Interpreters for members who don’t speak English or are hearing or speech impaired......................................... 27If you need interpreter services............................................................................................................................. 27Protection for the disabled..................................................................................................................................... 27Complaints ............................................................................................................................................................ 28Complaints: What should I do if I am unhappy?........................................................................29What is a grievance?............................................................................................................................................. 29How to file a grievance.......................................................................................................................................... 29iiCommunity 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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Member Handbook - Los Angeles County Department of Health ...

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