L.A. Care is not required to provide continuity of care for an out-of-network provider for certain ancillary (supporting) services such as radiology, laboratory, dialysis centers, or transportation. You will get these services with a provider in L.A. Care’s network.
To learn more about continuity of care and if you qualify, call Member Services 1-888-839-9909 (TTY 711).
Completion of covered services from an out-of-network provider
As a member of L.A. Care, you will get covered services from providers in L.A. Care’s network. If you are being treated for certain health conditions at the time you enrolled with L.A. Care or at the time your provider left L.A. Care’s network, you might also still be able to get Medi-Cal services from an out-of-network provider.
You might be able to continue care with an out-of-network provider for a specific time period if you need covered services for these health conditions:
| HEALTH CONDITION | TIME PERIOD |
|---|---|
| Acute conditions (a medical issue that needs fast attention) | For as long as your acute condition lasts |
| Serious chronic physical and behavioral conditions (a serious health care issue you have had for a long time) | For an amount of time required to finish your course of treatment and to safely move you to a new doctor in the L.A. Care network |
| Pregnancy and postpartum (after birth) care | During your pregnancy and up to 12 months after the end of pregnancy |
| Maternal mental health services | For up to 12 months from the diagnosis or from the end of your pregnancy, whichever is later |
| Care of a newborn child between birth and 36 months old | For up to 12 months from the start date of the coverage or the date the provider’s contract ends with L.A. Care |
| Terminal illness (a life-threatening medical issue) | For as long as your illness lasts. You may still get services for more than 12 months from the date you enrolled with L.A. Care or the time the provider stops working with L.A. Care |
| Performance of a surgery or other medical procedure from an out-of-network provider as long as it is covered, medically necessary, and authorized by L.A. Care as part of a documented course of treatment and recommended and documented by the provider | The surgery or other medical procedure must take place within 180 days of the provider’s contract termination date or 180 days from the effective date of your enrollment with L.A. Care |
For other conditions that might qualify, call Member Services at 1-888-839-9909 (TTY 711).
If an out-of-network provider is not willing to keep providing services or does not agree to L.A. Care’s contract requirements, payment, or other terms for providing care, you will not be able to get continued care from the provider. You may be able to keep getting services from a different provider in L.A. Care’s network.
For help choosing a contracted provider to continue with your care or if you have questions or problems getting covered services from a provider who is no longer in L.A. Care’s network, call Member Services at 1-888-839-9909 (TTY 711)
L.A. Care is not required to provide continuity of care for services Medi-Cal does not cover or that are covered under Medi-Cal’s contract with DHCS.
To learn more about continuity of care, eligibility, and available services, call Member Services.
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