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

Medi-Cal Member Handbook / Benefit Year 2006-2007If you don’t agree with the decision....................................................................................................................... 30How to appeal urgent complaints.......................................................................................................................... 30Voluntary mediation .............................................................................................................................................. 30Contacting the California Department of Managed Health Care (DMHC) ............................................................. 30How to appeal health care services denied or delayed as not medically necessary ............................................. 31IMRs for Experimental and Investigational Therapies (IMR-EIT) ......................................................................... 32State Fair Hearing................................................................................................................................................. 33Expedited State Hearing ....................................................................................................................................... 33Ombudsman Office ............................................................................................................................................... 33Arbitration: Solving problems without going to court.............................................................................................. 33Confidentiality: What are my privacy rights?............................................................................35Health information privacy..................................................................................................................................... 35Medi-Cal: How can I make sure I don’t lose my coverage?......................................................37Keeping your Medi-Cal Eligibility........................................................................................................................... 37If you move you must tell us!................................................................................................................................. 37Two types of Medi-Cal .......................................................................................................................................... 37Mandatory Medi-Cal Managed Care members ..................................................................................................... 37Voluntary Medi-Cal Managed Care members ....................................................................................................... 38Voluntary disenrollment......................................................................................................................................... 38Involuntary disenrollments..................................................................................................................................... 38Expedited disenrollment........................................................................................................................................ 39Transitional Medi-Cal ............................................................................................................................................ 39Getting involved: How do I participate? ....................................................................................40Community Health Plan Public Policy Committee................................................................................................. 40L.A. Care Regional Community Advisory Committees (RCAC)............................................................................. 40Board of Governors meetings ............................................................................................................................... 40Communicating policy changes............................................................................................................................. 40More important information: What else do I need to know?....................................................41If you travel outside of Los Angeles County .......................................................................................................... 41How a provider gets paid....................................................................................................................................... 41If you have other insurance................................................................................................................................... 41Workers' Compensation........................................................................................................................................ 41Third party liability ................................................................................................................................................. 41Disruption in services ............................................................................................................................................ 41iiiCommunity 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