L.A. Care is a managed care plan. L.A. Care provides care to members who live or work in Los Angeles County.
In managed care, your PCP, specialists, clinic, hospital, and other providers work together to care for you.
L.A. Care contracts with medical groups to provide care to L.A. Care members. A medical group is made up of doctors who are PCPs and specialists. The medical group works with other providers such as laboratories and durable medical equipment suppliers. The medical group is also connected with a hospital. Check your L.A. Care ID card for the names of your PCP, medical group, and hospital.
When you join L.A. Care, you choose or are assigned to a PCP. Your PCP is part of a medical group. Your PCP and medical group direct the care for all of your medical needs. Your PCP may refer you to specialists or order lab tests and X-rays. If you need services that require pre-approval (prior authorization), L.A. Care or your medical group will review the pre-approval (prior authorization) and decide whether to approve the service.
In most cases, you must go to specialists and other health professionals who work with the same medical group as your PCP. Except for emergencies, you must also get hospital care from the hospital connected with your medical group.
Sometimes, you might need a service that is not available from a provider in the medical group. In that case, your PCP will refer you to a provider who is in another medical group or is outside the network. Your PCP will ask for pre-approval (prior authorization) for you to go to this provider.
In most cases, you must have prior authorization from your PCP, medical group, or L.A. Care before you can go to an out-of-network provider or a provider who is not part of your medical group. You do not need pre-approval (prior authorization) for emergency services, family planning services, or in-network mental health services.
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