Issue link: https://digital.copcomm.com/i/431369
45 The People's Guide 2015 Medi-Cal doctor and your health plan choice for each person in the family who is required to choose a health plan. Your packet will include a directory with some of the doc- tors, doctor groups, medical groups and health plan choices in your area. If you don't see your doctor you can call Health Care Options and ask for a county or other area directory, or just call your clinic and ask which plans they take. Fill out the "choice form" and send it back to Health Care Op- tions within 30 days. Keep the pink copy of the form for your records. Mail the form in the postage paid envelope provided, or send the form by certified mail. If you don't complete the form and return it within 30 days, the state will choose a health plan for you that may not be convenient for you. To get a packet or more information, call Health Care Options at (800) 430-4263 or (800) 430-9009. The TDD line for hearing impaired is (800) 430-7077. If you have questions or problems call the Health Consumer Center at (800) 896- 3203 for assistance. It is very important to consult with any health care provider you already have and want to keep seeing before choosing a plan. You should also ask if you can keep going to the clinic, pharmacy and hospital that you want. You and your other family members may choose to join the same health plan and chose the same doctor, called a "Primary Care Provider" (PCP), or you can choose different health plans and PCPs. Once you select a health plan, you will be mailed a plastic health plan member- ship card to use when you need medical services. Enrollment usually takes 30-45 days. If you or your family need medical care before you receive the health plan card, you may use the regular State Medi- Cal Benefits Identification Card (BIC), or if you are already in an health plan and are just switching plans, use your current health plan until you are told you are in the new one. People in the groups that may, but do not have to, enroll in a health plan will au- tomatically get a packet in the mail even though they do not have to join a plan. You should not be asked to make a choice of a health plan when you apply or at your renewal. People who are already in a health plan when they apply for Medi-Cal should not get a packet in the mail. You may be asked to attend a "Health Care Options" talk. You do not have to go. If you go, you do not have to choose a plan that day unless you want to. 8. If You Move Be sure to report your change of address to your eligibility worker. Keep using your Medi-Cal card. If you move to a new county, report the change if you can to DPSS and also to the welfare office in the new county. The counties should manage the transfer of your case. If you move to another county you may also have to change your managed care plan. To change your plan call Health Care Options at 1-800-430-4263. 9. If You Were Billed Twice The doctor or health service provider cannot bill both you and Medi-Cal for the same care. If you think your doctor has billed you unfairly, you should contact the Health Consumer Center at (800) 896-3203 or Legal Aid (800) 399-4529. 10. Lost or Stolen Cards Notify your worker and a replacement card will be sent to you. If there is a medical emergency, you may receive a written notice of eligibility at your welfare office. How Do I Choose My Care? There are two ways to receive your medical care under Medi-Cal: • "Fee for service" (regular Medi-Cal), • or Managed Care (Health Plan). These are also called HMOs (Health Main- tenance Organizations). Most Medi-Cal participants must enroll in a Health Plan. Medi-Cal recipients who may, but do not have to, enroll in an Health Plan include: • Children in foster care or the Adoption Assistance Program • People who get health care from an Indian Health Service Program. Medi-Cal recipients who cannot enroll in a Medi-Cal Managed Care Health Plan • People who get Medi-Cal only for emer- gency and pregnancy related services (restricted Medi-Cal) • Recipients with a Share of Cost, re- stricted Medi-Cal or who also have one of the following; private insurance, or CHAMPUS PRIME HMO. 1. Fee-for-Service (Regular Medi-Cal) In regular Medi-Cal you can use any doctor, clinic, hospital, pharmacy or other provider willing to accept Medi-Cal. You must tell the doctor or clinic that you have Medi- Cal before you get care. If you don't, the provider can legally bill you for all services that you get. A provider cannot accept your Medi-Cal for some part of your care and then charge you money and refuse to bill Medi-Cal for other parts of your care, unless that provider does not provide that service under Medi-Cal. For example, a doctor cannot accept your Medi-Cal for your prenatal care but then refuse to bill Medi-Cal for your blood tests and try to charge you. 2. Managed Care ("Health Plan") When you join a health plan, you must see the doctors, pharmacists and hospitals that are part of your plan. You must select a health plan and a primary care provider that is in the health plan. Unless you have an emergency, you must get approval for most of your care from your primary care provider. The health plan will receive money each month for your health care even if you don't get services. The health plan is responsible for providing or making arrangements for you to get all Medi-Cal covered services. You should first see your doctor within four months of joining the health plan. You can contact Health Care Options (HCO) at (800) 430-4263 to enroll or change plans. After you are in a health plan, you may still use your Benefits Identification Card (BIC) to get family planning, dental, and mental health services outside of the health plan. If you have any questions contact Legal Aid (pg. 68). 3. Dental Care Dental care is fee-for-service in Los An- geles unless you choose to join a dental plan. In fee-for-service, you must get all your dental services from a dental provider willing to accept Medi-Cal. If you are in fee-for-service you can find a dentist by calling (800) 322-6384 Monday through Friday 8 am to 5 pm, or online at www. denti-cal.ca.gov. If you enroll in a dental plan, you will recieve primary care from the dentist you selected. If you are In a dental plan and want to switch to fee for service dental care call Health Care Options at (800)430-4263 for help. 4. How to Choose a Health Plan When you first enroll in Medi-Cal you will get a packet in the mail from the state. The packet will contain a "Medi-Cal Choice Form" that must be filled out with the