The People's Guide

35th Edition 2013-2014

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47 The People's Guide 2013-2014 7. Hearings, Grievances, and Leaving a Managed Care Health Plan If your health plan denies services or you are not satisfied with the services, you have many options. You can file a griev- ance with your health plan. Your health plan must tell you how to file a grievance. The health plan must resolve your griev- ance within 30 days, or less if you have an emergency. If you are still not satisfied complain in writing to the Department of Managed Health Care HMO Help Center, IMR Unit, 980 Ninth Street, Suite 500, Sacramento, CA 95814-2725. Their phone number is (888) HMO-2219, TDD (877) 688-9891. Or you can go to their website at Mandatory participants in health plans can change to a different plan for any reason. Voluntary participants can change plans or can go back to regular Medi-Cal for any reason. To change or leave a health plan, call Health Care Options at (800) 430-4263 and request a "choice form." If you want help with complaints and grievances call an advocacy group for as- sistance or call: Health Care Consumer Center (800) 896-3203 Managed Care Ombudsman (888) 452-8609 Department of Managed Care (888) HMO-2219 Medi-Cal Managed Care Ombudsman (888) 452-8609 You can also find information online at You can call (800) 400-0815 if your health plan gives you problems. If your health plan is denying you care because it does not think it is medically necessary, but you disagree, you can ask for an independent medical review which is done by a group of doctors and professionals who do not work for your health plan. You have the right to ask for a fair hearing. (see page 66, "Hearings and Complaints.") While waiting for a state hearing, the health plan must continue to provide medical services to you. 8. Mental Health Managed Care Mental Health services for Medi-Cal recipi- ents are also provided through a managed care system operated through "Local Mental Health Plans" in each county. For further discussion of these services (see page 52 "Mental Health Services.") Medi-Cal MEDI-CAL FOR TEENS If you are between 12 and 21 years old, you can apply for "Minor Consent Services" to get free and confidential medical treat- ment without parental consent related to: • Drug or alcohol abuse (except metha- done treatment) • Sexually transmitted infections • Pregnancy and abortion • Family planning • Outpatient mental health (not overnight in a hospital) • Sexual abuse. If you are under 21 and living with your parents, or temporarily away such as in school, you may apply for Minor Consent Medi-Cal to cover those specific services without your parents' consent or knowl- edge. If you are a minor who is living on your own you may apply for regular Medi- Cal by yourself. Your parents won't be required to give in- formation about their income or resources or pay toward the medical services, unless you want Medi-Cal for services other than those listed above. The DPSS won't tell your parents or send Medi-Cal mailings to your home without your permission. ''Minor Consent Services" are available regardless of your immigra- tion status. They provide more services than Medi-Cal that is restricted due to immigration status. To apply, fill out the regular Medi-Cal application and another short form for Minor Consent Services at DPSS or with a DPSS Worker at the site where you are receiving care. You will have to fill out a new short form each month you need treat- ment, except for mental health services. For that, you need a letter from a mental health professional explaining that you meet certain conditions for getting mental health services and how long you will need treatment. You will still have to complete the short form each month to update your eligibility. If you already get Medi-Cal through your parents' case, you may already have a plastic Medi-Cal card. But don't use the plastic card for Minor Consent services. CONTACT YOUR WORKER OR GET HELP ON YOUR CASE If you have trouble calling your worker, it may be because some offices now use the Customer Service Line -866-613-3777. You will need your case number or your client ID number for them to look up your case. The Client ID# is located on any M/C notice of action in the upper right hand corner of the notice (the last line of information after your name, case no, etc. In some cases, the customer service representative may be able to look up your case info with your name and date of birth. To look up your case on the computer you will need the Client ID # and a PIN number. You should have received a PIN number on a separate notice. The computer will have updated information on the status of your case. You can also call 211 and they can give you the DPSS Customer Service Line or Help Line numbers. Central Help Line / Customer Service Line CENTRAL HELP LINE 1-877-597-4777 for all of LA County They will help you with things like: • Need card number • Direct number of worker • Case number (if caller is on the case) • Card number (if caller is on the case) • If caller has moved and needs to get Medi-Cal in another state, city or county – they can tell you if you have an active case in LA CUSTOMER SERVICE LINE – (866)613-3777 for specific district offices Look at page 70- DPSS offices using the Customer Service Line. A representative from Customer service can access your case instead of calling the workers directly. They will help you with small changes and issues like: • Report change of address • Telephone number changed • Change in income (making more or less) • Need to contact worker You will need your client ID #, case no. or they might look you up with your name and birthdate if you don't know other information.

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