You do not have to pay for covered services unless you have a share of cost for long-term care. To learn more about members with long-term care and a share of cost, visit the Costs section of this online handbook. In most cases, you will not get a bill from a provider. You must show your L.A. Care ID card and your Medi-Cal BIC when you get health care services or prescriptions, so your provider knows who to bill. You can get an Explanation of Benefits (EOB) or a statement from a provider. EOBs and statements are not bills.
If you do get a bill, call Member Services at 1-888-839-9909 (TTY: 711).
If you get a bill for prescriptions, call Medi-Cal Rx at 1-800-977-2273 (TTY 800-977-2273 and press 5 or 711) or visit the Medi-Cal Rx website.
Tell L.A. Care the amount you are being charged, the date of service, and the reason for the bill. You do not need to pay providers for any amount owed by L.A. Care for any covered service. You must get pre-approval (prior authorization) from L.A. Care before you visit an out-of-network provider except when:
- You need emergency services, in which case dial 911 or go to the nearest hospital
- You need family planning services or services related to testing for sexually transmitted infections, in which case you can go to any Medi-Cal provider without pre-approval (prior authorization)
- You need mental health services, in which case you can go to an in-network provider or a county mental health plan provider without pre-approval (prior authorization)
If you get care from an out-of-network provider and you did not get pre-approval (prior authorization) from L.A. Care, you might have to pay for the care you got. If you need to get medically necessary care from an out-of-network provider because it is not available in the L.A. Care network, you will not have to pay as long as the care is a Medi-Cal covered service and you got pre-approval (prior authorization) from L.A. Care for it.
For more information about these services, visit the sections of this online handbook listed below:
If you get a bill or are asked to pay a co-pay that you don't think you have to pay, call Member Services at 1-888-839-9909 (TTY: 711).
If you pay the bill, you can file a claim with L.A. Care. You will need to tell L.A. Care in writing why you had to pay for the item or service. L.A. Care will decide if you can get money back.
For questions call Member Services at 1-888-839-9909 (TTY 711).
If you get services in the Veterans Affairs system or non-covered or unauthorized services received outside of California, you might be responsible for payment.
L.A. Care will not pay you back if:
- The services are not covered by Medi-Cal such as cosmetic services.
- You have an unmet Medi-Cal Share of Cost.
- You went to a doctor who does not take Medi-Cal and you signed a form that said you want to be seen anyway and you will pay for the services yourself.
- You asked to be paid back for co-pays for prescriptions covered by your Medicare Part D plan.