As an LA Care member in California, accessing healthcare services is straightforward within Los Angeles County. However, understanding your coverage when you are outside of the LA Care service area is crucial. This guide clarifies what steps to take when you require medical attention outside of Los Angeles County, ensuring you receive the necessary care while adhering to LA Care guidelines.
Navigating Non-Emergency Care Away from Home
For situations that are not emergencies or urgent matters and you are outside of Los Angeles County, your first step is to contact your Primary Care Physician (PCP) immediately. Alternatively, you can reach out to LA Care Member Services at 1-888-839-9909 (TTY: 711) for guidance. It’s important to understand that for non-emergency or non-urgent care needed outside of the LA Care service area and provider network, pre-approval is mandatory before receiving services. Always prioritize contacting your PCP or LA Care Member Services to initiate this pre-approval process and ensure your care is covered.
Emergency Care: Your Coverage is Assured
In case of a medical emergency, your immediate action should be to call 911 or proceed to the nearest emergency room without delay. LA Care provides coverage for emergency care even when it’s out-of-network, ensuring you receive prompt medical attention when it’s critically needed.
This coverage extends to specific international locations as well. If you are traveling in Canada or Mexico and encounter a medical emergency requiring hospitalization, LA Care will cover the costs of your care. However, it’s important to note that if you are traveling outside of Canada or Mexico, LA Care will not cover emergency care, urgent care, or any other healthcare services you may require.
Should you pay out-of-pocket for emergency care that required hospitalization in Canada or Mexico, you have the option to request reimbursement from LA Care. LA Care will review your request to determine eligibility for repayment.
Furthermore, if you find yourself in another state within the US or a US Territory such as American Samoa, Guam, Northern Mariana Islands, Puerto Rico, or US Virgin Islands, your emergency care is also covered. While not all hospitals and doctors accept Medicaid (known as Medi-Cal in California), it’s essential to inform the hospital or emergency room staff as soon as possible that you have Medi-Cal through LA Care when seeking emergency treatment outside of California.
To facilitate billing, request the hospital to make copies of your LA Care ID card and instruct them to bill LA Care directly for the services. If you receive a bill for out-of-state emergency services, contact LA Care immediately. LA Care will then coordinate with the hospital and/or doctor to ensure payment for your care is arranged.
For emergency outpatient prescription needs when you are outside of California, direct the pharmacy to contact Medi-Cal Rx at 1-800-977-2273 to process your prescription.
Urgent Care Needs Out of Area
If you require urgent care outside of the LA Care service area, seek treatment at the closest urgent care facility. It’s important to remember that LA Care does not cover urgent care if you are traveling outside of the United States.
Additional Resources and Support
The California Children’s Services (CCS) Program is available for children under 21 with specific health conditions. If your child requires services for a CCS-eligible condition and LA Care’s network lacks a CCS-paneled specialist, you may be authorized to seek care from an out-of-network provider at no cost. More details about the CCS program are available in the California Children’s Services section of the LA Care handbook.
For any questions regarding out-of-network or out-of-service-area care, LA Care Member Services is your primary contact at 1-888-839-9909 (TTY: 711). If Member Services is unavailable, the LA Care Nurse Advice Line is accessible 24/7, including holidays, at 1-800-249-3619 (TTY 711) for immediate assistance and health advice.
By understanding these guidelines, LA Care members in California can confidently navigate healthcare needs even when outside of their usual service area, ensuring continuous access to care when and where they need it.
