How to See a Doctor

You may choose the doctor or clinic you already use, if the doctor or clinic participates with L.A. Care Health Plan Medicare Advantage HMO. Or you may choose a new doctor from the Provider Directory. The Provider Directory gives you a listing of all medical groups, PCPs, specialists and hospitals contracted with L.A. Care Health Plan Medicare Advantage HMO, and has helpful information about each doctor and clinic.

When you choose a PCP, you will also need to select a medical group. Your PCP must be with the same medical group that you choose. When you pick your PCP and medical group, you are also choosing the other providers you will be able to see. Before you choose a PCP and medical group, you need to know with which set or group of providers, specialists and hospitals the PCP works.

If there is a particular L.A. Care Health Plan Medicare Advantage HMO specialist or hospital that you want to use, check first to be sure your PCP belongs to the same medical group as that specialist, and uses that hospital. The name and office telephone number of your PCP is printed on your membership card.

You may also change your PCP at any time. Call Member Services at 1-888-839-9909 (TTY 1-866-522-2731) to choose or to change your PCP. L.A. Care Health Plan representatives are available 24 hours a day, 7 days a week, including holidays.

How to Get Care From Your Primary Care Provider (PCP)

To see your PCP, call your PCP's office to make an appointment. Your PCP's phone number is printed on your L.A. Care Health Plan membership card. We recommend that you make sure to see your PCP for preventive care and see your PCP at least annually, not just when you are sick or have an immediate need.

How to Get Care From Specialists and Other Network Providers

When your PCP thinks that you need specialized treatment, he/she will give you a referral (approval in advance) to see a network specialist or certain other providers. For some types of referrals, your PCP may need to get approval in advance from your medical group or our Plan (this is called getting “prior authorization”).

It is very important to get a referral (approval in advance) from your PCP before you see a network specialist or certain other providers (there are a few exceptions, including routine women’s health care that we explain in Chapter 3, Section 2.2 in the Evidence of Coverage (PDF)). If you don’t have a referral (approval in advance) before you get services from a specialist, you may have to pay for these services yourself. If the specialist wants you to come back for more care, check first to be sure that the referral (approval in advance) you got from your PCP for the first visit covers more visits to the specialist.

If there are specific specialists you want to use, find out whether your PCP sends patients to these specialists.

Each network PCP has certain network specialists they use for referrals. This means that the L.A. Care Health Plan Medicare Advantage HMO specialists you can use may depend upon the PCP you select. You can change your PCP at any time if you want to see a network specialist that your current PCP can’t refer you to. See Chapter 3, Section 2 in the Evidence of Coverage (PDF) for how to change your PCP. If there are specific hospitals you want to use, you must first find out whether your PCP or the doctor you will be seeing uses these hospitals.

See our Provider Directory (PDF) for the most current listing of Providers in our contracted network. Call L.A. Care Health Plan Member Services department at 1-888-839-9909 (TTY 1-866-522-2731) if you would like one sent to you. L.A. Care Health Plan representatives are available 24 hours a day, 7 days a week, including holidays.