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					          Medi-Cal
          Program

A Helpful Guide to Your Health Care Benefits
       Una guía útil para sus beneficios de atención de la salud
Ձեր առողջապահական խնամքի նպաստների օգտակար ուղեցույց

                             건강보험 혜택에 관한 안내서
            Moät höôùng daãn höõu ích veà caùc lôïi ích y teá cuûa quyù vò

         ភៅម ុ​        ជ     ​ ពោ ក រ ់​ ក ្ច​        ស ភា រ     លោ អ
      សៀវ​ ​ គ្គទ្ទេសក៍​ ំនួយចំ​ ះ​ មេ​ ៉ាបរង​ ិចថេទាំ​ ុខ​ ព​បស់​ ក​ ្នក

                                             您的健康護理福利指南
                   Полезное руководство к Вашим пособиям
                             по медицинскому страхованию
         (Makatutulong na) Patnubay sa Iyong mga Benepisyo
                        sa Pangangalagang Pangkalusugan


                                                           2010/2011
                                                                                                         A Helpful Guide to Your Health Care Bene ts




               Thank you for your membership with L.A. Care Health Plan.
               When you join, and then every year, you will get this package of important information in the mail. It is
               about your health coverage. We need you to read and understand it.
                  is Member Handbook you are reading contains the Evidence of Coverage and Disclosure Form (EOC). It
               has the terms and conditions of your health care bene ts, summarizes the L.A. Care Health Plan (L.A. Care)
               policies and rules, and tells you how to get health care. e Member Handbook is broken down into the
               following sections:
                 •   Combined Evidence of Coverage and Disclosure Form ......................................................... 1
                 •   Preventive Health Guidelines – How to Stay Healthy ..........................................................59
                 •   Preventive Health Guidelines – How to Keep Your Child or Teen Healthy .......................63
                 •   Notice of Privacy Practices ........................................................................................................67
                 •   Nurse Advice Line – List of Audio Health Topics ...................................................................71
                 e information listed below can be found in this Member Handbook:
               Basic Information
                 • What bene ts and services are covered
                 • What bene ts and services are not covered
                 • How your health plan makes decisions about when new treatments will become bene ts
                 • What care you can and cannot get when you are out of Los Angeles County or the L.A. Care network
                 • How to access care when you are out of Los Angeles County
                 • How to change or get care from your primary care physician (PCP)
                 • How to get information about doctors
                 • How to get a referral for special care or to go to the hospital
                 • What to do when you need care right away or when the o ce is closed
                 • What to do if you have an emergency
                 • How to get prescriptions lled and other pharmacy program information
                 • Co-payments and other charges
                 • What to do if you get a bill
               Special Programs
                 • Programs to improve care and services for our members
                 • Programs for people with a disease, like diabetes or asthma
               How Decisions Are Made About Your Care
                • How our doctors and sta make decisions about your care based only on need and bene ts. We do not
                  encourage doctors to provide less care than you need and doctors are not paid to deny care.
                • How to reach us if you want to know more about how decisions are made about your care
                • How to appeal a decision about your care
               Member Issues
                • Your rights and responsibilities as a health plan member
                • How to complain when you are unhappy
                • What to do if you are disenrolled from your plan
                • How L.A. Care protects and uses your personal health information
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                • How to get help if you speak a di erent language
               You may view this Member Handbook before enrollment in the Medi-Cal program. Be sure to see our Web
               site www.lacare.org, or call us at 1-888-839-9909 if you would like paper copies.
                                                      2010–2011 Medi-Cal Member Handbook




Medi-Cal
Member Handbook
… a helpful guide to getting services
(Combined Evidence of Coverage and Disclosure Form)




Benefit Year 2010–2011




L.A. Care Health Plan
555 West Fifth Street
Los Angeles, CA 90013
Toll-free: 1-888-839-9909
TTY/TDD: 1-866-LACARE1 (1-866-522-2731)
Fax: 213-623-8097
Office Hours: Monday through Friday, 8 a.m. to 5 p.m.
Web site address: www.lacare.org
                                                                                 2010–2011 Medi-Cal Member Handbook



As an L.A. Care member, you have                                  the right to receive emergency treatment whenever and
the right to…                                                     wherever you need it.
  Respectful and courteous treatment. You have the                  Service and information in your language. You have
right to be treated with respect, dignity and courtesy from       the right to request an interpreter at no charge instead of
your health plan’s providers and sta . You have the right to      using a family member or friend to interpret for you. You
be free from retaliation or force of any kind when making         should not use children to interpret for you. You have the
decisions about your care.                                        right to get the Member Handbook and other information
                                                                  in another language or format (such as audio, large print
  Privacy and con dentiality. You have the right to have          or Braille).
a private relationship with your provider and to have your
medical record kept con dential. You also have the right            Know your rights. You have the right to receive
to receive a copy of, amend, and request corrections to           information about your rights and responsibilities. You
your medical record. If you are a minor, you have the right       have the right to make recommendations about these
to certain services that do not need your parents' okay.          rights and responsibilities.

  Choice and involvement in your care. You have the
right to receive information about your health plan, its          As an L.A. Care member, you have a
services, its doctors and other providers. You have the right     responsibility to…
to choose your primary care provider (PCP doctor) from              Act courteously and respectfully. You are responsible
the doctors and clinics listed in your health plan’s provider     for treating your doctor and all providers and sta with
directory. You also have the right to get appointments            courtesy and respect. You are responsible for being on time
within a reasonable amount of time. You have the right to         for your visits or calling your doctor’s o ce at least 24
talk with your doctor about any care your doctor provides         hours before your visit to cancel or reschedule.
or recommends, discuss all treatment options, and
participate in making decisions about your care. You have           Give up-to-date, accurate and complete information.
the right to a second opinion. You have the right to talk         You are responsible for giving correct information and as
candidly to your doctor about appropriate or medically            much information as you can to all of your providers, to
necessary treatment options for your condition, regardless        L.A. Care. You are responsible for getting regular checkups
of the cost or what your bene ts are. You have the right to       and telling your doctor about health problems before they
information about treatment regardless of the cost or what        become serious.
your bene ts are. You have the right to decline treatment.          Follow your doctor’s advice and take part in your
You have a right to decide in advance how you want to be          care. You are responsible for talking over your health care
cared for in case you get a life-threatening illness or injury.   needs with your doctor, developing and agreeing on goals,
                                                                  doing your best to understand your health problems, and
  Voice your concerns. You have the right to complain
                                                                  following the treatment plans and instructions you both
about L.A. Care, the health plans and providers we work
                                                                  agree on.
with, or the care you get without fear of losing your
bene ts. L.A. Care will help you with the process. If you           Use the Emergency Room only in an emergency. You
don’t agree with a decision, you have the right to appeal,        are responsible for using the emergency room in cases of an
which is to ask for a review of the decision. You have the        emergency or as directed by your doctor.
right to disenroll from your health plan whenever you
                                                                    Report wrong-doing. You are responsible for reporting
want. As a Medi-Cal member, you have the right to
                                                                  health care fraud or wrongdoing to L.A. Care. You can do
request a State Fair Hearing.
                                                                  this without giving your name by calling the L.A. Care
  Service outside of your health plan’s provider network.         Compliance Helpline toll-free at 1-800-400-4889 or
You have the right to receive emergency or urgent services        you could call the Department of Health Care Services
as well as family planning and sexually transmitted disease       (DHCS) Medi-Cal Fraud and Abuse Hotline toll-free at
services outside of your health plan’s network. You have          1-800-822-6222.
Table of contents
     Welcome: ank you for choosing
     L.A. Care Health Plan!                                                                            6      How to keep seeing your doctor if your doctor
      When your care starts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6               leaves your health plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
      Your health plan choices with L.A. Care . . . . . . . . . . . . . . . . . 6                             How to keep seeing your doctor if you
                                                                                                                are a new member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
      How to change health plans . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
                                                                                                              Care outside of L.A. Care’s network . . . . . . . . . . . . . . . . . . . . 18
      How to change your Health Maintenance
        Organization (HMO) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
                                                                                                             What is covered: What kinds of
      is Member Handbook:                                                                                    health care can I get from L.A. Care?                                                      19
     Why is it important to you?                                                                       8      Covered benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
      Need this handbook in another language? . . . . . . . . . . . . . . 8
      Whom do I call and when? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
                                                                                                             More benefits:
      Helpful information on the Internet at www.lacare.org . . 9                                            What other services can I get?                                                             26
                                                                                                              California Children’s Services (CCS) . . . . . . . . . . . . . . . . . . . . . 26
     Let’s get started:                                                                                       Child Health and Disability Prevention (CHDP) . . . . . . . . . 26
     How do I get health care?                                                                      10        Women, Infants and Children (WIC) Program. . . . . . . . . . . 26
      Your PCP doctor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10          Special services for American Indians . . . . . . . . . . . . . . . . . . 26
      Start getting your care now! Call your PCP doctor                                                       Medi-Cal benefit changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
          for a checkup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10      Services you can get outside of your health plan . . . . . . . 27
      How to see your PCP doctor . . . . . . . . . . . . . . . . . . . . . . . . . . 10
      How to get care when your PCP doctor’s                                                                 Non-covered services:
          office is closed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11      What does Medi-Cal not cover?                                                              29
      If you get a bill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
      What is a second opinion? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11                 Pharmacy benefits:
      How to get a second opinion. . . . . . . . . . . . . . . . . . . . . . . . . . 12                      How do I get prescription drugs?                                                           30
      Are you pregnant? Call L.A. Care at 1-888-839-9909 . . . . 12                                           What is a pharmacy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
      How to get health care that your PCP doctor can’t give you . . .12                                      How to get a prescription filled . . . . . . . . . . . . . . . . . . . . . . . .30
      How to get a standing referral with a specialist. . . . . . . . . 12                                    Prescription refills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
                                                                                                              What is a formulary? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
     ID cards: How do I use them?                                                                   14        Drugs not on the formulary . . . . . . . . . . . . . . . . . . . . . . . . . . .30
      What to do with your L.A. Care ID card . . . . . . . . . . . . . . . . . 14                             What drugs are covered? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
      What to do with your Medi-Cal card                                                                      What drugs are not covered? . . . . . . . . . . . . . . . . . . . . . . . . . . 31
       (also known as BIC card) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14                    Emergency contraception (“Plan B”) . . . . . . . . . . . . . . . . . . . 31
                                                                                                              Prescription authorization process for emergencies or
     Our provider network:                                                                                      urgent circumstances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
     Who gives me health care?                                                                      15        Medicare Part D: Prescription drug coverage for
      Your PCP doctor gives you most of your care . . . . . . . . . . 15                                        beneficiaries who get both Medicare and Medi-Cal . . . 32
      How to change your PCP doctor. . . . . . . . . . . . . . . . . . . . . . . 15
      Kinds of PCP doctors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16            Emergency care: How do I get care in
      Choosing a Federally Qualified Health Center (FQHC)                                                    an emergency?                                                                              33
         as your PCP doctor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16              How to get urgent care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
      How to get care from a specialist . . . . . . . . . . . . . . . . . . . . . . 16                        What is emergency care? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
      Our doctors' professional qualifications . . . . . . . . . . . . . . . . 16                             What to do in an emergency . . . . . . . . . . . . . . . . . . . . . . . . . . 33
      Certified Nurse Midwives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17                 Outside of Los Angeles County . . . . . . . . . . . . . . . . . . . . . . . .34
      Certified Nurse Practitioners . . . . . . . . . . . . . . . . . . . . . . . . . . . 17                  What to do after an emergency . . . . . . . . . . . . . . . . . . . . . . .34
      What care can you get from a provider who is not                                                        How to get emergency transportation . . . . . . . . . . . . . . . . .34
         your PCP doctor? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17            Not sure you have an emergency? . . . . . . . . . . . . . . . . . . . . .34

iv   Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
                                                                                                                                       2010–2011 Medi-Cal Member Handbook




Help in another language and for people                                                                       Mandatory Medi-Cal Managed Care members . . . . . . . . . 45
with disabilities: How can I get help?                                                              35        Voluntary Medi-Cal Managed Care members . . . . . . . . . .46
 Information in other languages . . . . . . . . . . . . . . . . . . . . . . . . 35                            Voluntary disenrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46
 Interpreters for members who don’t speak English                                                             Involuntary disenrollments . . . . . . . . . . . . . . . . . . . . . . . . . . . .46
     or are hearing or speech impaired. . . . . . . . . . . . . . . . . . . 35                                Expedited disenrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
 If you need interpreting services . . . . . . . . . . . . . . . . . . . . . . . 35                           Transitional Medi-Cal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
 Protection for people with disabilities. . . . . . . . . . . . . . . . . . 35
 Complaints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36          Getting involved: How do I participate?                                                    48
                                                                                                              L.A. Care Public Policy Committee . . . . . . . . . . . . . . . . . . . . .48
Complaints: What should I do if I am                                                                          L.A. Care Regional Community Advisory
                                                                                                                 Committees (RCAC). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48
unhappy?                                                                                            37        Board of Governors meetings . . . . . . . . . . . . . . . . . . . . . . . . .48
 What is a grievance? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37                Communicating policy changes . . . . . . . . . . . . . . . . . . . . . . .48
 How to file a grievance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
 If you don’t agree with the outcome of your grievance .38                                                   More important information:
 How to file a grievance for urgent cases . . . . . . . . . . . . . . .38                                    What else do I need to know?                                                               49
 If you don’t agree with the outcome of your
     grievance for urgent cases . . . . . . . . . . . . . . . . . . . . . . . . . .38                         If you travel outside of Los Angeles County . . . . . . . . . . . . 49
 Independent Medical Review. . . . . . . . . . . . . . . . . . . . . . . . . . 39                             How a provider gets paid. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
 IMRs for Experimental and Investigational                                                                    If you have other insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
     Therapies (IMR-EIT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39                 Workers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
 Contacting the California Department of                                                                      Third party liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
     Managed Health Care (DMHC) . . . . . . . . . . . . . . . . . . . . . .40                                 Medi-Cal Estate Recovery Program . . . . . . . . . . . . . . . . . . . . 49
 State Fair Hearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40               Disruption in services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
 Expedited State Hearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41                     Organ donation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
 Ombudsman Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41                      What is an advance directive? . . . . . . . . . . . . . . . . . . . . . . . . .50
 Arbitration: Solving problems without going to court.. . 41                                                  New technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
 Voluntary mediation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
                                                                                                             Glossary of Terms                                                                          51
Confidentiality: What are my privacy                                                                          Important Phone Numbers                                                                    57
rights?                                                                                            42
 Health information privacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
 Protect yourself from identity theft . . . . . . . . . . . . . . . . . . . . 43

Fraud, waste & abuse: How to identify
and report it                                                                                      44
 Fraud . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
 Waste. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
 Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
 How to report fraud, waste and abuse. . . . . . . . . . . . . . . . . .44
 Why should you care about fraud, waste and abuse? . . .44
 Preventing health care fraud. . . . . . . . . . . . . . . . . . . . . . . . . . .44

Medi-Cal: How can I make sure
I don’t lose my coverage?                                                                           45
 Keeping your Medi-Cal eligibility . . . . . . . . . . . . . . . . . . . . . . 45
 If you move you must tell us! . . . . . . . . . . . . . . . . . . . . . . . . . . 45
 Two types of Medi-Cal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

                                                                        Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).                                                        v
Welcome: ank you for
choosing L.A. Care Health Plan!
      L.A. Care is a government agency that was created           Your health plan choices with L.A. Care
    over 10 years ago to help Los Angeles County Medi-Cal
                                                                    L.A. Care works with ve (5) Health Plan Partners
    members get quality health care. L.A. Care is also called
                                                                  to provide health care services for members.
    the Local Initiative Health Authority for Los Angeles
    County. But you can call us “L.A. Care.”                        L.A. Care and the Health Plan Partners have
                                                                  contracts with many doctors, hospitals, pharmacies
      With the help of the health plans we work with,
                                                                  and other health care providers to serve you. When a
    L.A. Care serves nearly 800,000 members in Los Angeles
                                                                  Medi-Cal member joins L.A. Care, the member can
    County. We only serve people who live in Los Angeles
                                                                  choose to receive services through:
    County (called our “service area”). L.A. Care Health
    Plan is the largest public health plan in the nation. We         • Anthem Blue Cross
    are growing because we are a trusted source for health           • Care1st Health Plan
    care and we respect our members.                                 • Community Health Plan
                                                                     • Kaiser Permanente
    When your care starts                                            • L.A. Care Health Plan
      To enroll in the Medi-Cal program, call or visit the           L.A. Care and the Health Plan Partners are pre-paid
    Los Angeles County Department of Public Social Services       health coverage programs called “health maintenance
    o ce (DPSS) near you. Once DPSS nds you eligible,             organizations,” or HMOs. L.A. Care and the Health
    you can enroll in a health plan of your choice. Enrollment    Plan Partners are licensed with the State of California.
    in a health plan can take between 15 to 45 days.                 e State of California has given L.A. Care and the
      While your enrollment in a health plan is processed,        Health Plan Partners permission to serve you. e State
    you can access your Medi-Cal bene ts using the Bene ts        of California pays for your health care. ere is no cost
    Identi cation Card (BIC) sent to you by the California        to you when you get services covered by Medi-Cal.
    Department of Health Care Services. e bene ts you               When you chose L.A. Care for your Medi-Cal,
    access during this time are covered by Medi-Cal.              you also chose L.A. Care as your health plan. (If you
      Your care through L.A. Care starts when your                did not choose a health plan, we chose one for you).
    enrollment in a health plan is complete. You can start        L.A. Care is responsible for almost all of your health
    using your Medi-Cal bene ts through L.A. Care on your         care services. Some bene ts, like dental and vision, are
    e ective date of coverage. Your e ective date of coverage     not provided by your health plan. You can learn more
    is the 1st day of the month following completion of           about this in the “More bene ts: What other services
    enrollment in a health plan. Check the L.A. Care member       can I get?” section of this handbook.
    ID card mailed to you for the e ective date of coverage.




6   Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
                                                                               2010–2011 Medi-Cal Member Handbook




How to change health plans                                    How to change your Health
  We believe you will like L.A. Care. But you can             Maintenance Organization (HMO)
change your health plan for any reason. Call L.A. Care          You can also leave L.A. Care to enroll with another
at 1-888-839-9909 to change your health plan. If you          health maintenance organization (HMO) at any time
call L.A. Care before the 20th of the month, the change       and for any reason. To change your HMO, call Health
will be e ective on the 1st of the next month. If you call    Care Options (HCO). You can nd HCO’s phone
L.A. Care on or after the 20th of the month, the change       number in the “Important Phone Numbers” section of
will start on the 1st of the month following the next         this handbook. When you change your HMO, you will
month. For example, if you call on June 15th to change        get a new ID card and Member Handbook from your
health plans, the change will become e ective on July         new HMO. Be sure to tear up your old ID card.
1st. If you call after June 20th to change health plans,
the change will become e ective August 1st. When you
change health plans, you will get an ID card from your
new health plan. Be sure to tear up your old health plan
ID card.
  Some plans do not serve all of Los Angeles County.
Call the health plan to ask about their service area and
to make sure it can serve you before you change. You
can't get routine care like checkups outside of your
health plan’s service area. But don’t worry: No matter
which health plan you choose, you can get urgent or
emergency care anywhere when you need it – even
outside of Los Angeles County. For more information,
see the “Emergency care: How do I get care in an
emergency?” section of this handbook.




                                       Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).   7
 is Member Handbook:
Why is it important to you?
        is Member Handbook has important information.
    Keep this handbook where you can nd it easily. is
    handbook contains information on:
      • How and from whom to get care                               sUmTUrs&BæeTA L.A. Care ebIG~kcg'Vn esovePA
                                                                    t¨maenH CaPasaExµr . (Khmer)
      • What types of care are and are not covered
                                                                    L.A. Care 에게 전화를 하시면 이 핸드북을 다른
      • Who to contact if you have problems                         언어로 받아보실 수 있습니다. (Korean)
      • Your rights regarding Medi-Cal and how you are
        treated                                                     Tumawag sa L.A. Care kung kailangan mo ang
                                                                    handbook sa lengguwaheng ito. (Tagalog)
      In this handbook, we use “you” and “your” to
    mean “the Medi-Cal member.” Only the member                     Позвоните в офис L.A. Care, если Вам необходим
    can get the bene ts talked about in this handbook.              данный справочник на следующем языке
                                                                    (Russian)
      Your Member Handbook is also called the
    Combined Evidence of Coverage and Disclosure                    Xin goïi L.A. Care neáu quyù vò muoán coù cuoán caåm
    Form. It gives only a summary of L.A. Care Health               nang baèng ngoân ngöõ naøy. (Vietnamese)
    Plan policies and rules. You must look at the contract
    between L.A. Care and the California Department                 Call L.A. Care’s Member Services
    of Health Care Services (DHCS) to learn the exact
    terms and conditions of coverage. Call L.A. Care if
                                                                    if you would like this handbook or
    you would like a copy of the contract.                          other materials that you may receive
                                                                    from L.A. Care in large print, Braille,
                                                                    audio or an alternative format.
    Need this handbook in another language?
      Call L.A. Care if you would like your handbook in
      this language. (English)
                                                                  Whom do I call and when?
                                                                    You can call your Primary Care Provider (PCP) –
      Llame a L.A. Care si desea una copia del manual en          your doctor – when you:
      este idioma. (Spanish)
                                                                    • Need an appointment
      лé³Ó³ÛÝ»ù L.A. Care »Ã» ó³ÝϳÝáõÙ »ù                         • Need a checkup
      ëáõÛÝ ï»Õ»Ï³·ÇñÝ áõÝ»Ý³É Ñ»ï»õÛ³É É»½íáí`                     • Are sick
      (Armenian)
                                                                    • Need urgent care services in Los Angeles County
      如果您想取得後述語言的手冊,請致電                                             • Have a health question
      L.A. Care。(高棉文) (Chinese)
                                                                    Your doctor’s name and telephone number are on your
                                                                  ID card.


8   Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
                                                                               2010–2011 Medi-Cal Member Handbook




  You can call L.A. Care when you:                            plan. Since this information is private, you will need to
  • Need a new ID card                                        log in. Go to www.lacare.org to nd out what to do.
  • Want to change your PCP doctor                              Be sure to have your ID card ready because we will ask
  • Have questions about services and how to get them         for your member ID number.
  • Want to know what’s covered or what is not covered
  • Need help getting the care you need
  • Get a bill from a doctor
  • Are pregnant
  • Have a problem you can’t solve
  • Want to change health plans from L.A. Care to a
    di erent health plan
  • Are unsure who to call
  L.A. Care’s toll-free number is 1-888-839-9909.


Helpful information on the Internet at
www.lacare.org
   Do you use the Internet? Our Web site, www.lacare.org,
is a great resource. You can:
  • Find a doctor
  • Learn about the nurse advice line and how and when
    to use it
  • Learn about your bene ts
  • Learn more about privacy rights
  • Learn about health education services
  • Find out about your rights and responsibilities
  • File a complaint (called a “grievance”)
  • Learn about fraud, waste and abuse and how to
    report suspected fraud, waste and abuse
  You can also check your eligibility for medical
coverage. You can even request to change your health




                                       Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).   9
Let’s get started:
How do I get health care?
      In this handbook, we will call your primary care provider       When you need a checkup or if you get sick, you need
    (PCP) “your PCP doctor.” Your PCP doctor is responsible         to go to your PCP doctor. Call your PCP doctor. e
    for making sure you get the medical care you need and are       phone number is on your ID card.
    entitled to.
      You were asked to choose a PCP doctor and a health
    plan when you lled out the Medi-Cal enrollment form.            Start getting care now! Call your
    Sometimes we can't give you the PCP doctor you choose.          PCP doctor for a checkup.
    Some of the reasons are:                                           It is important for new members to get a checkup even
      •     e doctor is not taking new patients.                    if they are not sick. Be sure to schedule a checkup soon af-
                                                                    ter becoming an L.A. Care member. Call your PCP doc-
      •     e doctor does not work with the health plan you         tor today to make an appointment for a “new member
          chose.                                                    checkup.” is visit is also called a “well visit” or “initial
      •     e doctor only sees patients of a certain age or only    health assessment.” Your PCP doctor’s telephone number is
          women (Ob/Gyns).                                          on your L.A. Care ID card.
      •     e doctor does not work with L.A. Care.                        is rst visit is important. Your PCP doctor looks at your
      If you did not get the PCP doctor or health plan you chose,   medical history, nds out what your health status is today,
    call L.A. Care at 1-888-839-9909 to see if that PCP doctor      and can begin any new treatment you might need. You and
    or health plan is available.                                    your PCP doctor will also talk about preventive care. is
                                                                    is care that helps “prevent” you from getting sick or keeps
      Each member has a PCP doctor. A PCP doctor can even           certain conditions from getting worse. Remember, children
    be a clinic. You can choose one PCP doctor for all members      need to get a checkup every year, even when they are not
    of your family in Medi-Cal. Or you can choose a di erent        sick, to make sure they are healthy and growing properly.
    PCP doctor for each member of your family in Medi-Cal.
    Women can choose an Ob/Gyn or family planning clinic as
    their PCP doctor.                                               How to see your PCP doctor
                                                                       1. Call your PCP doctor’s o ce to schedule an
    Your PCP doctor                                                       appointment. You should get an appointment to see
      Your PCP doctor gives you “primary” (or basic) medical              your PCP doctor within 10 business days from the
    care. Health care services you can get from your PCP doctor           date of your call. Your PCP doctor’s phone number is
    include:                                                              on your L.A. Care ID card.
      • Routine care                                                   2. Be on time for your appointment. If you need
                                                                          directions, call the PCP doctor’s o ce.
      • Checkups (also called “well visits”). is is when you go
        to your PCP doctor when you are not sick, like when            3. If you can’t go to your appointment, call the
        you need immunization shots. It is important to see               PCP doctor’s o ce right away. By canceling your
        your PCP doctor even when you are not sick!                       appointment, you allow someone else to be seen by
                                                                          the doctor.
      • Sick care. ese visits are when you see your PCP doctor
        because you are not feeling well.                              4. If you miss your appointment, call right away to make
                                                                          another appointment.
                                                                       5. Show the PCP doctor’s o ce your ID card when you
                                                                          are there.
10 Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
                                                                                2010–2011 Medi-Cal Member Handbook


                                                                You should not be billed for emergency care, urgent
       Important! You can still get services without          care, the care required to stabilize an emergency
your ID card. If you need to see your PCP doctor,             condition, family planning services, or for sexually
                                                              transmitted disease testing at a clinic. If you receive a
your PCP doctor (or hospital or pharmacy) can call
                                                              bill, do not pay it. Call L.A. Care right away to take care
L.A. Care so you can get care.                                of the bill for you.
                                                                 Do not pay medical bills you get from a collection
How to get care when your                                     company. If you get a bill for covered services and need
PCP doctor’s o ce is closed                                   help or if you want to le a complaint, call Member
  If you need care when your PCP doctor’s o ce is closed      Services at L.A. Care Health Plan. When your doctor
(such as after normal business hours, on the weekends or      receives proof that you had Medi-Cal at the time of your
holidays), call your PCP doctor’s o ce. Ask to speak to       visit, your doctor must let the collection company know
your PCP doctor or to the doctor on call. A doctor will       you had Medi-Cal at that time. If you had Medi-Cal
call you back.                                                at the time of your doctor visit, you can't be charged
                                                              for covered medical services. Your doctor must tell the
   You can also call the nurse advice line number that        collection company to stop trying to make you pay
is on your ID card. is number is available to you 24          the bill. e doctor may have to pay up to three (3)
hours a day, seven (7) days a week, to help answer your       times what is owed if he/she does not tell the collection
health care questions and have your health concerns and       company to stop trying to make you pay the bill. If you
symptoms reviewed by a registered nurse. is service           get a bad credit report because of an unpaid medical bill
is free of charge and available to you in your language.      for covered services, the doctor has up to 30 days from
  For urgent care (this is when a condition, illness or       the time they found out about your Medi-Cal to correct
injury is not life-threatening, but needs medical care        it or have it deleted.
right away), call or go to your nearest urgent care center.
Many of L.A. Care’s doctors have urgent care hours in
                                                              What is a second opinion?
the evening, on weekends or during holidays.
                                                                You have the right to ask for and get a second opinion
                                                              at no cost to you. You also have the right to ask for a
If you get a bill                                             timely response to your request for a second opinion. A
  L.A. Care pays for all covered medical costs approved       second opinion is a visit with another doctor when:
by your PCP doctor or for an emergency. You should not          • You question a diagnosis for a chronic condition or
get a bill for any services covered by L.A. Care. Please          for a condition that endangers your life or body. (A
call L.A. Care right away if you receive a medical bill.          diagnosis is when a doctor identi es a condition,
L.A. Care will make sure the doctor stops sending you             illness or disease.)
a bill.
                                                                • You do not agree with your PCP doctor or specialist’s
  You may get a medical bill if you go to a doctor that           treatment plan. (A treatment plan is what the
does not work with L.A. Care or is located outside of             doctor says is best for you, based upon the doctor’s
L.A. County. If this happens, then you may be billed              diagnosis.)
by the doctor and you may have to pay for services
that are not covered by L.A. Care. If you pay the bill,         • You would like to make sure your treatment plan is
keep a copy or record of your payment. Send a copy                right for you.
of your payment to L.A. Care for review. If the bill is            e second opinion must be from a quali ed health care
for covered or authorized services, you may receive a         professional in the L.A. Care network. (A quali ed health
refund from L.A. Care.                                        care professional is a person who has the training and
                                                              expertise to treat or review a speci c medical condition.)

                                                                                                                   >>
                                        Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731). 11
     If there is no quali ed health care professional within      How to get health care that your
   L.A. Care’s network, then L.A. Care will authorize             PCP doctor can’t give you
   (or okay) a second opinion by a quali ed health care
                                                                    Sometimes you need care your PCP doctor can’t give
   professional outside L.A. Care’s network.
                                                                  you. You may need care from a specialist or a hospital. To
                                                                  see a specialist or for treatment at a hospital, your PCP
   How to get a second opinion                                    doctor must authorize (or okay) the care, and give you a
     To get a second opinion:                                     “referral.” A referral is a request from your PCP doctor to
                                                                  another doctor or to the hospital for health care services
     1. Talk to your PCP doctor, specialist or L.A. Care and      or treatment you may need. Your PCP doctor will start
        let them know you would like to see another doctor        the referral process. You MUST get a referral BEFORE
        and the reason why.                                       you get specialized health care services or treatment at a
     2. Your PCP doctor, specialist or L.A. Care will refer       hospital (except for emergency care, urgent care, or if you
        you to a quali ed health care professional. If you are    need to see an Ob/Gyn).
        requesting a second opinion about a diagnosis that          Routine referrals take up to ve (5) business days to
        your PCP doctor made, the second opinion shall            process (business days are Monday through Friday), but
        be from a PCP doctor of your choice from the same         may take up to 10 business days if more information is
        physician organization as your PCP doctor’s. If you       needed from your PCP doctor. In some cases, your PCP
        are requesting a second opinion about a diagnosis         doctor may ask to “rush” your referral. Expedited (rush)
        that your specialist made, a second opinion must          referrals may not take more than three (3) calendar days.
        come from any independent physician association           Please call L.A. Care if you do not get a response by
        (IPA) or medical group within the network for             these times.
        the same specialty. If there is no quali ed health           If a referral is not approved, your PCP doctor or
        care professional within your plan’s network,             L.A. Care will tell you why. You will receive a letter
        L.A. Care will authorize (or okay) a second opinion       explaining why the referral was not authorized or
        by a quali ed provider outside the network.               denied. If you do not agree with the explanation given,
     3. Call the second opinion doctor to make an                 you may le a complaint. For information on how to le
        appointment.                                              a complaint, turn to the “Complaints: What should I do
                                                                  if I am unhappy?” section of this handbook.
     4. Show the doctor’s o ce your ID card.
                                                                    Emergency services anywhere or urgently needed
     You may complain if your health plan denies your             services when outside of Los Angeles County do not
   request for a second opinion or if you do not agree with       need a referral.
   the second opinion. is is also called “ ling a grievance.”
   You can learn more about this in the “Complaints: What
   should I do if I am unhappy?” section of this handbook.        How to get a standing referral with a specialist
                                                                     You may need to see a specialist (or other quali ed health
   Are you pregnant? Call L.A. Care at                            care professional) for a long time if you have a condition
   1-888-839-9909                                                 or disease that is chronic (such as diabetes or asthma),
                                                                  life-threatening (such as HIV/AIDS) or disabling.
     Call your health plan right away if you are pregnant
   or become pregnant. is is because we want you and                    is is called a “standing referral.” A standing
   your baby to be healthy. en, call your PCP doctor or           referral is made to a specialist who is in L.A. Care’s
   Ob/Gyn to make an appointment. You should get an               network or who is with a contracted specialty care
   appointment to see your PCP doctor or Ob/Gyn within            center. If L.A. Care does not have a quali ed specialist,
   14 calendar days from the date of your call. When you          L.A. Care will send you to a specialist outside their network.
   are pregnant, it is important to get care right away,            A standing referral needs an approval by L.A. Care.
   throughout your pregnancy and after you give birth.            You can ask your PCP doctor for a standing referral. Or,

12 Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
                                                                               2010–2011 Medi-Cal Member Handbook


your doctor can ask L.A. Care for a standing referral.
L.A. Care must decide on your request for a standing
referral within three (3) business days. Once you have a
standing referral, you will not need permission for each
visit with the specialist.
  Your specialist will develop a treatment plan for you.
   e treatment plan will show how often you need to go
to the doctor. Once the treatment plan is approved, the
specialist will coordinate the care you get. is specialist
will be authorized to provide health care services the
same way your PCP doctor would, based on his or her
skill, training and the treatment plan.




                                       Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731). 13
ID cards:
How do I use them?
    What to do with your L.A. Care ID card                        What to do with your Medi-Cal
      Along with this handbook you received an L.A. Care          card (also known as BIC card)
    ID card for every family member covered by Medi-Cal.               e State of California sent you another ID card, your
    If you did not receive an ID card for a family member         Medi-Cal Bene ts Identi cation Card (also called a BIC
    who is covered by Medi-Cal, call L.A. Care right away.        card). You need to show your Medi-Cal card whenever
       Your L.A. Care ID card has important information on        you get services you don’t get from L.A. Care. You can
    it, including:                                                learn more about these services in the “More bene ts:
                                                                  What other services can I get?” section of this hand-
      • Your PCP doctor’s name (or the name of your clinic        book. Call the California Department of Public Social
        or medical group)                                         Services (DPSS), toll-free at 1-877-481-1044 if you need
      • Your PCP doctor’s phone number                            a new Medi-Cal card.
      •     e 24-hour nurse advice line and member services
          phone numbers
                                                                         Never let anyone use your health plan ID card
                                                                  or Medi-Cal card. This is called fraud. You can lose
      Here’s what to do with your ID card:
                                                                  your Medi-Cal bene ts if someone else uses your ID
      • Check to make sure the information on your ID
        card is correct. Is your name spelled right? Is your      cards to get care. If you lose your Medi-Cal bene ts,
        birth date right? If anything on your ID card is          L.A. Care will not be able to give you care.
        wrong, call L.A. Care at 1-888-839-9909 right
        away. L.A. Care will connect you to the California
        Department of Public Social Services (DPSS), toll-
        free at 1-877-481-1044, to get it xed.
      • Keep your ID card in a safe place. If you lose
        or damage your ID card, call L.A. Care at
        1-888-839-9909
     •    Show your ID card whenever you:
          º Have   a doctor’s appointment
          º Go   to the hospital
          º Need    emergency services
          º Pick   up a prescription




14 Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
Our provider network:
Who gives me health care?
  Please read the following information so you will         shown in the provider directory mailed to you with
know from whom or what group of providers you can           this handbook. Call L.A. Care for another copy of the
get health care.                                            provider directory or to help you choose another
  L.A. Care works with a large group of doctors,            PCP doctor.
specialists, pharmacies, hospitals and other health care      You can change your PCP doctor for any reason if
providers. is group is called a “network.” You can get      you are not happy. To change your PCP doctor, call
a copy of L.A. Care’s network by calling 1-888-839-         L.A. Care. You may choose a PCP doctor within the
9909 and asking for a provider directory.                     rst 30 calendar days of enrollment and change at
  In most cases, you need to get care within                least monthly after that.
L.A. Care’s network. at is not the case if you need
emergence care or need urgent care outside of Los                 ings to remember if you choose a new PCP doctor:
Angeles County. You can learn more about this in the          • Some doctors work within a group of doctors with
“Emergency care: How do I get care in an emergency?”            certain specialists, hospitals and other health care
section of this handbook.                                       providers. If you need a specialist, your PCP doctor
                                                                may send you to these providers. If you are going to
                                                                a specialist already or want to use a speci c hospital,
Your PCP doctor gives you most of your care                     talk with the PCP doctor you are choosing.
   Your PCP doctor is responsible for making sure you         • A PCP is a doctor or even a clinic. You can pick
get the health care bene ts you need and should receive         one PCP doctor for all members of your family in
from Medi-Cal.                                                  Medi-Cal or you can pick a di erent PCP doctor
                                                                for each member of your family in Medi-Cal.
                                                                Women may choose an Ob/Gyn or family
How to change your PCP doctor                                   planning clinic as their PCP doctor.
  If you didn’t choose a PCP doctor when you enrolled         • Ask about o ce access if you or a family member
in Medi-Cal, a PCP doctor was chosen for you                    has a disability.
by L.A. Care. Your PCP doctor was chosen for you
based on:                                                       e PCP doctor you choose may not agree to treat
 •    e language you speak                                  you and may ask L.A. Care to make a change. is can
                                                            happen if:
 • Your age
                                                              • You are disruptive or disrespectful to your doctor or
 • How close you live to the PCP doctor’s o ce                  your doctor’s o ce sta .
  It is best to stay with the same PCP doctor. Your PCP       • You do not follow your doctor’s treatment plan.
doctor gets to know your health history and health            •     e service or care you need are not within the
needs. If you can't stay with the same PCP doctor, you            doctor’s scope of care (like a high-risk pregnancy).
can choose a new one from the L.A. Care network




                                                                                                                >>
                                      Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731). 15
    Kinds of PCP doctors                                          Choosing a Federally Quali ed Health
      You can choose your PCP doctor from the L.A. Care           Center (FQHC) as your PCP doctor
    provider directory that came with this handbook. e              A Federally Quali ed Health Center (FQHC) is a
    kinds of physicians that can be PCP doctors are:              clinic and can be your PCP doctor. FQHCs get money
      • Family Practice                                           from the federal government because they are located
                                                                  in areas without a lot of health care services. Call
      • General Practice                                          L.A. Care for the names and addresses of the FQHCs
      • Internal Medicine                                         that work with L.A. Care or look in the provider
      • Pediatricians                                             directory mailed to you with this handbook.
      • Ob/Gyns (for female members only)
      Some hospitals and other providers may have a moral         How to get care from a specialist
    objection to providing some services. To ensure you              Your PCP doctor is the doctor who makes sure you
    can get the health care services you need, get more           get the care you need when you need it. Sometimes your
    information about the hospital or provider before you         PCP doctor will send you to a specialist. A “specialist”
    choose them. Also, some hospitals and other providers         is a doctor who is an expert in a certain kind of health
    do not provide one or more of the following services that     care. ese specialists are within your PCP doctor and
    may be covered under your plan contract and that you          L.A. Care’s network. If you need care from a specialist,
    or your family may need:                                      your PCP doctor must approve these services before you
      • Family planning                                           receive them. Routine referrals to a specialist take up
                                                                  to ve (5) business days and rush referrals (for when
      • Contraceptive services, including emergency
                                                                  you need medical care right away or have an urgent
        contraception
                                                                  condition) can't take more than three (3) calendar days.
      • Sterilization, including tubal ligation at the time of
                                                                    Female members who need Ob/Gyn care don’t need
        labor and delivery
                                                                  their PCP doctor’s okay to go to an Ob/Gyn or family
      • Infertility treatments                                    planning doctor with L.A. Care.
      • Abortion
      If a hospital or other provider tells you that it has a     Our doctors’ professional quali cations
    moral objection to providing you with these services,
                                                                    We are proud of our doctors and their professional
    you should call L.A. Care’s Member Services to ensure
                                                                  training. If you have questions about the professional
    you can get the health care services you need.
                                                                  quali cations of network doctors and specialists, call
                                                                  L.A. Care. L.A. Care can tell you about their medical
                                                                  training or quali cations.




16 Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
                                                                               2010–2011 Medi-Cal Member Handbook


Certi ed Nurse Midwives                                      How to keep seeing your doctor if
  Certi ed Nurse Midwife services are available outside      your doctor leaves your health plan
of L.A. Care’s network. Members may see a Certi ed             Sometimes L.A. Care stops working with a doctor or
Nurse Midwife without a PCP doctor’s okay. To nd             hospital. If this happens, we will let you know as soon as
out more, ask your PCP doctor or call L.A. Care.             we can. You can ask to keep seeing your doctor (including
                                                             specialists and hospitals) if that doctor agrees and has
                                                             been treating you for any of the following conditions:
Certi ed Nurse Practitioners                                   • An acute condition (a serious and sudden condition
  Some PCP doctors who work with L.A. Care have                  that lasts a short time like a heart attack, pneumonia
Certi ed Nurse Practitioners on sta to see patients.             or appendicitis) – for the time the condition lasts.
Members may see a Certi ed Nurse Practitioner. To see
                                                               • A serious chronic (long-term) condition – for a period
a Certi ed Nurse Practitioner, or for more information,
                                                                 of time necessary to complete a course of treatment
ask your PCP doctor or call L.A. Care.
                                                                 and arrange for a safe transfer to another provider.
                                                               • A pregnancy – during the pregnancy and immediate
What care can you get from a provider                            postpartum care (6 weeks after giving birth).
who is not your PCP doctor?                                    • A terminal illness/condition – for the length of the
    ere are some kinds of care that you can get from             illness/condition.
someone other than your PCP doctor:                            • Children from 0 to 36 months – for up to 12 months.
 • Emergency care. In an emergency, dial 911.                  • A surgery or other procedure authorized by
   Emergency services do not require a referral or an            L.A. Care as part of a documented course of
   okay from your PCP doctor or L.A. Care before you             treatment. is treatment was set to occur within
   get them.                                                     180 calendar days of the time the doctor or hospital
 • Urgent care when you are not in Los Angeles County            stops working with L.A. Care or within 180 calendar
   and can’t come back to Los Angeles County to get              days of the time you began coverage with L.A. Care.
   care. Call your PCP doctor if you are not sure how
   to get urgent care when you are not in Los Angeles
   County. Your PCP doctor or your doctor’s o ce will        How to keep seeing your doctor
   help you.                                                 if you are a new member
 • Family planning services and sexually transmitted           Members who have just joined L.A. Care may ask to
   disease testing. You may get these services from          keep seeing their doctor or hospital if they are in the
   any health care provider licensed to provide these        middle of treatment or have scheduled treatments or
   services. You do not need your PCP doctor’s okay to       procedures. is is called a “continuity of care” bene t.
   get these services.                                         You will not be eligible for the continuity of care
 • Specialist care. A “specialist” is a type of doctor who   bene t if EITHER:
   is an expert in a certain kind of health care. Your         • You are a new enrollee with L.A. Care and were
   PCP doctor will send you to a specialist if you need          o ered an opportunity from your previous health
   one. In most cases, you can't see a specialist without        plan to continue receiving care from an out-of-
   your PCP doctor’s okay.                                       network provider; or
 • Members may see an in-network Ob/Gyn for Ob/                • You had the option to continue care from your previous
   Gyn services without the PCP doctor’s okay.                   provider but still chose to change health plans.


                                                                                                                >>
                                       Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731). 17
      Doctors not contracted with L.A. Care may be
    required to agree to the same terms and conditions
    as contracted providers. If the doctor does not agree,
    L.A. Care is not required to provide the services
    through that doctor.
      You can get a copy of L.A. Care’s continuity of care
    policy by calling 1-888-839-9909. Please call L.A. Care
    and ask how to request “continuity of care.”


    Care outside of L.A. Care’s network
      As a member of L.A. Care your service area is
    Los Angeles County. For routine (regular) care, all
    health care services are provided in Los Angeles County.
    Routine care outside of L.A. County is not covered.
      In most cases, you need to get care within L.A. Care’s
    network and within Los Angeles County. However, you
    can always get emergency care or urgent care anywhere.
      If you get care from a non-contracted provider (a
    doctor or other provider that is not a part of L.A. Care’s
    network) or outside of Los Angeles County, you may be
    billed by the provider and you may have to pay, except
    for emergency care, urgent care, family planning and
    for sexually transmitted disease (STD) testing services.
    You can learn more about this in the “Emergency care:
    How do I get care in an emergency?” section of this
    handbook.




18 Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
What is covered: What kinds of
health care can I get from L.A. Care?
  In order for you to get any health care service through        Call L.A. Care at 1-888-839-9909 if you have
L.A. Care, the service must be both:                            questions about:
  • A covered bene t in Medi-Cal and                             • Your bene ts
  • Medically necessary.                                         • How or where to get bene ts
  A “covered bene t” means that you can get this                 • What is covered or not covered.
service through Medi-Cal and L.A. Care. “Medically               All covered bene ts are free.
necessary” means you need the service to get healthy
or stay healthy.
  All health care services are reviewed, modi ed                Covered bene ts:
(changed), approved or denied according to medical
necessity. If you would like a copy of the policies and         Alcohol/Drug Abuse
procedures L.A. Care uses to decide if a service is              • Crisis intervention
medically necessary, call L.A. Care. No doctor has to
                                                                 • Health education services
give you services that he/she doesn’t believe you need.
Services are subject to all terms, conditions, limits and
exclusions. You can learn more about this in the “Non-          Asthma Services
covered services: What does Medi-Cal not cover?”                 • Nebulizers (including face mask and tubing), inhaler
section of this handbook.                                          spacers and peak ow meters for management and
  All services require prior authorization unless                  treatment of asthma
the bene t says that it does not require prior                   • Member education on proper use of nebulizers,
authorization. “Prior authorization” means that your               inhaler spacers and peak ow meters for asthma
PCP doctor and L.A. Care agree that services and care
are necessary. You must have a prior authorization before
                                                                Cancer Screening
you get services or care, such as services from a specialist.
                                                                 • All generally medically accepted cancer screening
  Services that do not require prior authorization are:
                                                                   tests, including coverage for screening and diagnosis
  • PCP doctor visits                                              of prostate cancer
  • Emergency services                                           • Mammography for breast cancer screening
  • Urgently needed services when outside of                     • Cervical cancer screening test, including:
    Los Angeles County
                                                                   º Human    Papilloma Virus (HPV) screening
  • Family planning services
  • Preventive services                                            º   HPV vaccinations including, but not limited
                                                                       to, Gardasil® for girls and young women ages 9
  • Sexually transmitted disease (STD) services
                                                                       through 26
  • HIV testing
  • Basic prenatal care from a doctor who works with
    L.A. Care
  • In-network Certi ed Nurse Midwife/Ob-Gyn
                                                                                                                  >>
                                         Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731). 19
      • Cancer clinical trials. If you have cancer, you may             º   Insulin syringes
        be able to be part of a cancer clinical trial. A cancer         º   Visual aids, excluding eyewear, to assist the
        clinical trial is a research study with cancer patients to          visually impaired with proper dosing of insulin
          nd out if a new cancer treatment or drug is safe and
        treats a member’s type of cancer. e cancer clinical           • Training and health education for self-management
        trial must meet certain requirements, when referred           • Family education for self-management
        by your L.A. Care doctor or treating provider. It
        must have a meaningful potential to bene t you               Doctor’s O ce Visits
        and must be approved by one of the following: the
                                                                      • All routine visits, exams, treatments, required
        National Institute of Health (NIH), the Food and
                                                                        immunization shots and Child Health Disability
        Drug Administration (FDA), the U.S. Department
                                                                        Prevention Program (CHDP) visits are provided by
        of Defense or the U.S. Veteran’s Administration.
                                                                        your doctor
        If you are part of an approved cancer clinical trial,
        L.A. Care will provide coverage for all routine               • Services received from a specialist
        patient care cost related to the clinical trial.              • Any CHDP services from school-based programs or the
                                                                        Los Angeles County Department of Health Services.
       If you have a life-threatening or weakened condition,
                                                                           ere is more information about CHDP under the
    or were eligible but denied coverage for a cancer clinical
                                                                        “More bene ts: What other services can I get?”
    trial, you have the right to request an Independent
                                                                        section of this handbook. You can also call CHDP at
    Medical Review (IMR) on the denial. You can learn
                                                                        1-800-993-2437.
    more about this in the “Complaints: What should I do
    if I am unhappy?” section of this handbook.
                                                                     Drugs/Medications
    Diabetic Services                                                 • Prescription drugs and over-the-counter drugs on
                                                                        the L.A. Care formulary are covered. You can learn
        ese services are covered for diabetics when medically
                                                                        more about this in the “Pharmacy bene ts: How do
    necessary:
                                                                        I get prescription drugs?” section of this handbook.
      • Medical equipment
      • Prescription drugs                                           Durable Medical Equipment (DME)
      • Diabetes-related supplies:                                     DME is medical equipment used repeatedly (over and
        º   Blood glucose monitors and testing strips                over again) by a person who is ill or injured. ese items
        º   Blood glucose monitors designed to assist the            are ordered by your doctor. Examples include:
            visually impaired for insulin dependent, non-             • Apnea monitors
            insulin dependent and gestational diabetes                • Blood glucose monitors, including monitors for the
        º   Insulin pumps and all related necessary supplies            visually impaired for insulin dependent, non-insulin
        º   Ketone urine testing strips                                 dependent and gestational diabetes

        º   Lancets and lancet puncture devices                       • Insulin pumps and all related supplies

        º   Pen delivery systems for the administration               • Nebulizer machines
            of insulin                                                • Orthotics (shoe inserts)
        º   Podiatric devices of the feet (such as special            • Ostomy bags
            footwear or shoe inserts) to prevent or treat             • Oxygen and oxygen equipment
            diabetes-related complications
                                                                      • Prosthesis



20 Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
                                                                              2010–2011 Medi-Cal Member Handbook


 • Pulmo-Aides and related supplies                           Family planning services also include counseling
 • Spacer devices for metered-dose inhalers                 and surgical procedures for the termination of
                                                            pregnancy (called an abortion). Please call L.A. Care
 • Tubing and related supplies                              to find out more.
 • Urinary catheters and related supplies                     Many of our doctors who provide family planning
                                                            services are also Ob/Gyn specialists. Women may pick a
Emergency Services                                          PCP doctor from a list of family planning clinics located
  Emergency services are covered 24 hours a day, seven      near them. Call L.A. Care for a copy of this list.
(7) days a week, anywhere. Emergency care is a service        Women have the right to family planning services given
that a member reasonably believes is necessary to stop      by a family planning provider who is not in L.A. Care’s
or relieve:                                                 network. You do not need an okay from your PCP doctor
  • Sudden serious illnesses or symptoms                    to do this. L.A. Care will pay that doctor or clinic for the
                                                            family planning services you get.
  • Injury or conditions requiring immediate diagnosis
   and treatment                                                 e California Department of Health Care Services
                                                            (DHCS), O ce of Family Planning, can also answer
  Emergency services and care include ambulances,           questions or give you a referral for family planning
medical screening, examination, and evaluation by a         services. You can reach them at 1-800-942-1054.
doctor or appropriate personnel. Emergency services
include both physical and psychiatric emergency
                                                            Health Education Services
conditions, and active labor. You can learn more about
these in the “Emergency care: How do I get care in an         L.A. Care has health education materials, programs
emergency?” section of this handbook.                       and services to help you stay healthy and take care of
                                                            yourself.    ese programs are free. Health education
                                                            services can help members by:
Family Planning
                                                              • Promoting health: Learn to develop life-long
  Family planning services are provided to members of
                                                                healthy habits.
child-bearing age to help them choose the number and
spacing of children. ese services include all methods         • Preventing diseases: Learn how to prevent and care
of birth control approved by the Food and Drug                  for life-threatening illnesses.
Administration (FDA). You may receive family planning         • Helping you manage chronic diseases.
services and FDA-approved contraceptives from any             Learn more about these topics by talking to your
health care provider licensed to provide these services.    doctor or through health education services:
 Examples of family planning providers include:               • Asthma
 • Your PCP doctor                                            • Dental Health
 • Clinics                                                    • Diabetes
 • Certi ed Nurse Midwives and Certi ed Nurse                 • Drug and Alcohol Programs
   Practitioners
                                                              • Exercise/Fitness
 • Ob/Gyn specialists (doctors who specialize in
   female reproductive health care)                           • Family Planning/Birth Control
 • Planned Parenthood clinics                                 • HIV
                                                              • Healthy Foods
                                                              • High Blood Pressure

                                                                                                                 >>
                                      Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731). 21
      • Immunization (Shots)                                      Home Health
      • Parenting/Child Health                                         ese services are provided in the home by health care
      • Prenatal Health                                           personnel for all of the following:
      • Safety Tips                                                 • Short-term physical, occupational, and speech
                                                                      therapy
      • Sexually Transmitted Diseases (STDs)
                                                                    • Respiratory therapy when prescribed by a licensed
      • Tobacco Use (how to quit or prevent smoking)                  practitioner acting within the scope of his or her license
      • Weight Problems
                                                                    Home health services ordered by your doctor are
      • Violence/Abuse                                            provided by home health personnel such as:
                                                                    • Registered Nurses (RNs)
      Health education services include:
                                                                    • Licensed Vocational Nurses (LVNs)
      • Written materials (booklets)
                                                                    • Home Health Aides
      • Tapes, DVDs, CDs or videos
                                                                    • Medical Social Services
      • Referrals to health education classes or programs
      • Counseling (one-on-one teaching, phone or group)            If a service can be provided in more than one location,
                                                                  L.A. Care will work with the provider to choose the
      • Support groups                                            location.
      • Online community resource and health education
        information                                               Hospice Care
     For health education services information, visit                Care is limited to terminally ill members expected to
    L.A. Care online at www.lacare.org.                           live 12 months or less. If you decide to receive hospice
      Ask your doctor for health education materials and          bene ts, you are waiving all rights to all other bene ts
    classes. You can also call L.A. Care.                         for the terminal illness for the duration of the hospice
                                                                  election. e hospice election may be made of up to two
                                                                  (2) periods of 90 days each, one subsequent period of 30
    Hearing Aids
                                                                  days, and one 180-day extension of the 30-day period.
      Hearing aids are covered when ordered by your doctor.       Hospice services are not covered for more than 390 days.

    HIV Testing                                                   Hospital Care
      You can get con dential HIV testing from any health           Includes, but is not limited to:
    care provider licensed to provide these services. You do        • Inpatient services
    not need a referral or okay from your PCP doctor or
                                                                    • Intensive care
    health plan for con dential HIV testing. Examples of
    where you can get con dential HIV testing include:              • Outpatient services
      • Your PCP doctor
                                                                  Incontinent Creams and Washes
      • Los Angeles County Department of Health Services
                                                                   These are provided at no cost when there is a
      • Family planning services providers
                                                                  medical need.
      • Prenatal clinics
      Please call L.A. Care to request a list of testing sites.



22 Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
                                                                                    2010–2011 Medi-Cal Member Handbook


Lab Services                                                       If you are pregnant, call L.A. Care at 1-888-839-
  • Blood work                                                   9909 right away. We want to make sure you get the
                                                                 care you need. L.A. Care will help you choose your
  • Urine tests                                                  maternity care doctor from a doctor in your network.
  •       roat cultures                                          Ask your doctor to nd out more.
  Services must be provided at a network:                          After giving birth, you will receive breastfeeding
                                                                 education and special equipment if needed. Ask your
  • Doctor’s o ce
                                                                 doctor, or call L.A. Care if you have any questions.
  • Hospital
                                                                   Go to “Women, Infants and Children (WIC)
  • Laboratory                                                   Program” under the “More bene ts: What other services
                                                                 can I get?” section of this handbook for information
Mastectomy                                                       about nutrition and food stamps.
  Mastectomy is a surgery to remove a breast, due
to cancer.                                                       Minor Consent Services
  • Prosthesis (replacing a missing body part with an              There are some services adolescent members (12
    arti cial one)                                               to 21 years of age) can get without a parent’s okay.
                                                                 Minors can decide to get these services through their
  • Reconstructive surgery (see “Reconstructive Surgery”
                                                                 PCP doctor or from other qualified providers not
    in this section for more information)
                                                                 with L.A. Care’s network.
  You and your doctor decide how long you need to stay in
                                                                      e following services are covered:
the hospital after the surgery based on medical necessity.
                                                                   • Counseling and surgical procedures to end pregnancy
                                                                     (abortion)
Maternity Care
                                                                   • Drug and alcohol abuse services for members 12
  Maternity care includes:
                                                                     years of age or older
  • Regular doctor visits during your pregnancy (called
                                                                   • Family planning
    prenatal visits)
                                                                   • Pregnancy related services
  • Diagnostic and genetic testing
                                                                   • Sexual assault treatment (including rape)
  • Nutrition counseling
                                                                   • Sexually transmitted disease (STD) services for
  • Labor and delivery care
                                                                     members 12 years of age or older
  • Health care six (6) weeks after delivery (called
                                                                   • Outpatient mental health treatment and counseling
    postpartum care)
                                                                     for minors (12 to 21 years of age) who are mature
  • Inpatient hospital care for at least 48 hours after              enough to participate, and where either:
    normal vaginal deliveries or for at least 96 hours after
                                                                     º      ere is danger of serious physical or mental harm
    a Cesarean section. Coverage for inpatient hospital
                                                                         to themselves or to others; or
    care may be less than 48 hours or 96 hours if:
                                                                     º     ey are a victim of incest or child abuse.
      º     e decision is made by the mother and treating
          physician, and
      º   A post-discharge follow-up visit for the mother and
          newborn is made within 48 hours of discharge



                                                                                                                       >>
                                           Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731). 23
    Newborn Care                                                  Obstetrical/Gynecological (Ob/Gyn)
      Your newborn baby will be covered by L.A. Care for            Pregnant members do not need a referral or okay from
    the month of birth and the following month.                   their PCP doctor or L.A. Care to see an Ob/Gyn who
      When you have a baby, it is important to do three           works in their network. Please call L.A. Care if you have
    (3) things:                                                   any questions.
      1. Please call L.A. Care at 1-888-839-9909. We want
         to make sure you and your baby get the care you          Podiatry (services for the feet)
         need right away.                                           Podiatry services are limited and require prior authorization
      2. Contact your eligibility worker at DPSS toll-            except when received on an emergency basis.
         free at 1-877-481-1044 to enroll your baby in
         Medi-Cal. is is important so that your baby              Prenatal Care
         can continue to get Medi-Cal bene ts!                      • Regular doctor visits during your pregnancy (called
      3. Take your baby to the doctor within three (3)                prenatal visits)
         days of getting home from the hospital after               • Prenatal supplements
         delivery. A L.A. Care doctor in your network
         should see your newborn baby within a few                  • Diagnostic and genetic testing
         days of the birth. Call L.A. Care for more
         information on getting an appointment.                   Reconstructive Surgery

       Newborn baby screenings for certain treatable genetic        Reconstructive surgery to repair abnormal body parts,
    disorders are covered. ese genetic disorders include:         improve body function, or bring back a normal look.

       • Phenylketonuria (PKU)
                                                                  Sexually Transmitted Disease (STD) Services
       • Galactosemia
                                                                    STD services include:
       • Hypothyroidism
                                                                    • Preventive care
       • Hemoglobinopathies
                                                                    • Screening
       • Sickle cell disease
                                                                    • Testing
       •    alassemia
                                                                    • Diagnosis
       • Amino acid disorders
                                                                    • Counseling
       • Organic acid oxidation disorders
                                                                    • Treatment
       • Fatty acid oxidation disorders
                                                                    • Follow-up
       • Congenital adrenal hyperplasia (CAH)
       • Related blood disorders                                    You can get con dential STD services from any
                                                                  doctor or clinic. You do not need a referral or okay from
      Babies with these conditions will be referred to            your doctor.
    California Children’s Services (CCS) for treatment or to
    L.A. Care if the treatment is not covered by CCS.             Skilled Nursing Facility Services
      Treatment of PKU includes medically prescribed                A facility licensed to provide medical services for non-
    formulas and special food products. PKU cases are             acute conditions.
    followed by a health care professional who consults
    with a doctor specializing in PKU-related diseases. You         If you need long-term skilled nursing facility services,
    can learn about this in the “More bene ts: What other         you may be disenrolled from L.A. Care and provided these
    services can I get?” section of this handbook.                services through Medi-Cal or another state program.

24 Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
                                                                                2010–2011 Medi-Cal Member Handbook


Temporomandibular Joint (TMJ) Disease                             hospital to another hospital or facility, or facility to
 • A disease of the temporomandibular joint (TMJ)                 home when the transportation is:
   that connects the lower jaw to the skull.                      º   Medically necessary, and
  TMJ disease is covered only for medically necessary             º   Requested by the PCP doctor, and
surgery or treatment to realign the jaw, and not for a            º   Authorized in advance by L.A. Care.
dental disorder.                                                     Non-emergency medical transportation is available
                                                                  if the member is recovering from serious injury or
  erapy – Occupational, Physical and Speech                       medical procedure that prevents them from driving
 • Occupational therapy is used to improve and                    to a medical appointment, they have no other
   maintain a patient’s daily living skills because of a          form of transportation available, and the attending
   disability or injury.                                          physician (PCP doctor or specialist appointment is
                                                                  scheduled with) asserts that the member requires
 • Physical therapy uses exercise to improve and                  non-emergency medical transportation to and from
   maintain a patient’s ability to function after an              appointment on a speci ed date. If you need non-
   illness or injury.                                             emergency medical transportation, please call your
 • Speech therapy is used to treat speech problems.               PCP doctor or L.A. Care to see if you qualify for
                                                                  these services. You must have approval to get these
Topical Fluoride Varnish                                          services before the services are given.
  Topical Fluoride varnish helps prevent and control            Exclusion: Coverage for public transportation includ-
tooth decay. Topical application of uoride is a Medi-         ing transportation by airplane, passenger car, taxi, or
Cal bene t for children younger than 6 years of age, up       other forms of public conveyance.
to three times in a 12-month period.
                                                              Vision Care
Transportation                                                  Eye exams are covered by L.A. Care for all members
 • Emergency transportation for a member that                 under 21 years of age. You are limited to one pair of
   believes it is necessary to stop or relieve sudden         eyeglasses every two (2) years unless your prescription
   serious illnesses or symptoms, or injury or                changes.     is includes lenses and covered frames for
   conditions requiring immediate diagnosis and               eyeglasses when authorized. Diabetic members age 21
   treatment. Emergency transportation (ambulance)            and older are covered for eye exams only.
   or ambulance transport services provided through             To nd out more about eye exams or vision care
   the "911" emergency response system will be covered        coverage call L.A. Care.
   in a medical emergency when medically necessary.
 • Non-emergency medical transportation to medical            X-ray Services
   facilities is covered when your medical and physical           ese services will be provided when ordered by your
   condition does not allow you to take regular means         doctor from a network:
   of public or private transportation (car, bus, etc.) and
   you have a written prescription from your doctor.            • Doctor’s o ce
   Examples of non-emergency medical transportation             • Hospital
   include, but are not limited to, litter vans and             • Laboratory
   wheelchair vans. Also includes non-emergency
   transportation for the transfer of a member from a




                                        Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731). 25
More benefits:
What other services can I get?
      Medi-Cal members are entitled to other health care          Women, Infants and Children (WIC) Program
    bene ts and services that are not provided by L.A. Care.
                                                                    The Women, Infants and Children (WIC)
                                                                  Supplemental Nutrition Program gives pregnant women
                                                                  and new mothers nutrition information and coupons to
    California Children’s Services (CCS)
                                                                  buy healthy foods. Ask your doctor or maternity nurse
      CCS is for people under the age of 21 with a disability.    to nd out more about WIC. You may call WIC directly
    If your child has a chronic (long-term) medical illness,      at 1-888-942-9675.
    your child may be eligible for services under CCS.
      L.A. Care will identify children with CCS eligible
    conditions, arrange for a referral to the local CCS           Special services for American Indians
    o ce, and continue to provide case management until              American Indians have the right to get health
    eligibility is established with the CCS program. Primary      care services at Indian Health Centers and Native
    care services will continue to be provided by L.A. Care.      American Health Clinics. American Indians may stay
      Please call L.A. Care if your child is getting CCS          with or disenroll from L.A. Care while getting health
    services. L.A. Care can arrange for those services to         care services from an Indian Health Center or Native
    continue. Your child can continue getting services as         American Health Clinic. American Indians have a right
    a member of L.A. Care. You can call the Los Angeles           to not enroll in a Medi-Cal managed care plan or may
    County CCS o ce toll-free at 1-800-288-4584 to nd             leave their health plans and return to regular (fee-for-
    out more.                                                     service) Medi-Cal at any time and for any reason. Please
                                                                  call Indian Health Services at 1-916-930-3927 to nd
                                                                  out more. You may visit the Indian Health Services Web
    Child Health and Disability                                   site at www.ihs.gov to nd out more.
    Prevention (CHDP)
      Your child may get preventive services through his
                                                                  Medi-Cal bene t changes
    or her local school. CHDP services help keep children
    from getting sick and include regular checkups,                   e state cut a few bene ts from the Medi-Cal
    immunizations (shots), education and counseling, and          program. ese changes only a ect some adults age 21
    vision and hearing tests.                                     and older who are on Medi-Cal.
      You may call CHDP at 1-800-993-CHDP (1-800-                      ese changes do not a ect members under 21 years
    993-2437) if you have any questions.                          of age. Medi-Cal bene ts for members under 21 remain
                                                                  the same.
                                                                     ese bene ts will NOT change for Medi-Cal
                                                                  members who are:
                                                                    • Under the age of 21
                                                                    • Living in a skilled nursing facility (Level A or B.   is
                                                                      includes subacute care facilities.)




26 Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
                                                                                2010–2011 Medi-Cal Member Handbook




 • Pregnant (If you are pregnant, you can continue to           • Childhood lead poisoning (through the Los Angeles
   receive pregnancy-related bene ts and services. You            County Department of Health Services)
   can also receive other bene ts and services listed
   above to treat conditions that, if left untreated, might     • Chiropractic services (Limited – please see the
   cause di culties for the pregnancy.          is includes       “Medi-Cal benefit changes” section of this
   dental exams, cleanings and gum treatment. Dental              handbook)
   and other bene ts and services may also be available         • Direct Observed      erapy for the treatment of
   up to 60 days after the baby is born.)                         tuberculosis (through the Los Angeles County
 • Receiving bene ts through the California Children’s            Department of Health Services)
   Services (CCS) program
                                                                • Dental Services (Limited – please see the “Medi-
 • Receiving bene ts through a Program of All-                    Cal bene t changes” section of this handbook)
   Inclusive Care for the Elderly                                 that are normally done by a dentist, orthodontist or
  However, L.A. Care feels that ve (5) bene ts the state          oral surgeon, and dental appliances. You must get
cut are important to our members and will still provide           Dental Services through Denti-Cal. Call toll-free
these bene ts when there is a medical need.                       at 1-800-322-6384 to learn more. L.A. Care covers
 As an L.A. Care Medi-Cal member, you will                        dental screenings under the rst health checkup and
keep getting:                                                     will refer members to Medi-Cal dental providers.
                                                                  L.A. Care covers the following when medically
 • Speech therapy services                                        necessary: prescription drugs, lab services, outpatient
 • Podiatry (foot) services                                       surgical services, and inpatient services. General
 • Audiology (hearing) services                                   anesthesia for dental work is covered for members
                                                                  under seven (7) years of age, the developmentally
 • Incontinence creams and washes                                 disabled or when medically necessary.
 • Annual optometry (eye) exam for diabetic members
                                                                • Early Start/Early Intervention. Early Start/Early
                                                                  Intervention is for children ages 0 to 3. If your
Services you can get outside                                      PCP doctor tells you that your child is at risk for
of your health plan                                               developmental delays, your child may be eligible
  Some services are not covered by L.A. Care but are              for the Early Start program. Developmental delays
still bene ts. ey are available through Medi-Cal or               include di culties in communicating, adjusting to
another state program. Please call L.A. Care if you have          di erent situations, following directions or relating
any questions about the services below.                           to others. For more information about Early Start/
 • Acupuncture (Limited – please see the “Medi-Cal                Early Intervention or a referral to the Regional
   bene t changes” section of this handbook)                      Center for Early Start/Early Intervention, talk to
                                                                  your doctor or to L.A. Care.
 • Adult day health care
                                                                • Local Education Agency (LEA) assessment services
 • Alcohol and drug treatment services (outpatient)               are provided to students who qualify through the
                                                                  school system.

                                                                                                                  >>
                                        Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731). 27
      • Major organ transplants, except for renal or                • Prayer or spiritual healing
        corneal transplants.
                                                                    • State laboratory services under the state Serum
      • Members       with     developmental     disabilities.        Alpha-fetoprotein Testing Program
        Developmental disabilities include di culty learning
        and di culty with motor skills. If your PCP doctor          • Home and Community Based Services Waiver
        tells you that you have a developmental disability,           Program provides services beyond those that
        you may be eligible for services from the Regional            are covered by Medi-Cal.        ese services allow
        Centers. For more information about or for a referral         individuals to remain in a community setting rather
        to a Regional Center, talk to your PCP doctor or call         than be admitted to a long-term care facility.
        L.A. Care.
      • Mental health services. Mental health services may
        include treatment for anxiety, behavioral health
        problems or depression. Your PCP doctor will provide
        you with some outpatient mental health services
        within the scope of their training and practice. Call
        your PCP doctor for more information about mental
        health services available through your PCP doctor.

        Specialized mental health services may be
        needed for services beyond your PCP doctor’s
        training and practice. These services are
        provided through the Los Angeles County
        Department of Mental Health (LACDMH).
        You can receive services from LACDMH with or
        without a referral from your doctor. LACDMH
        can be reached toll-free at 1-800-854-7771.

        L.A. Care will coordinate and cover laboratory,
        radiological and radioisotope services needed for
        the diagnosis, treatment and monitoring of a mental
        health condition. L.A. Care or regular (fee-for-
        service) Medi-Cal cover mental health drugs listed
        on the formulary and prescribed by your PCP doctor
        or by a licensed mental health provider authorized to
        prescribe drugs. If medically necessary, you can also
        get a mental health drug not listed on the formulary.
        Go to a network pharmacy to ll your prescription.
        You can learn more about this in the “Pharmacy
        bene ts: How do I get prescription drugs?” section
        of this handbook.




28 Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
Non-covered services:
What does Medi-Cal not cover?
  The following is a list of services not covered                e following is a list of services not covered for
by L.A. Care or by the regular (fee-for-service)            some L.A. Care Medi-Cal members over the age of 21
Medi-Cal program:                                           (please see the “Medi-Cal bene t changes” section of
 • All services excluded from Medi-Cal under state          this handbook):
   and/or federal law                                         • Dental
 • Routine circumcision, unless medically necessary           • Chiropractic
 • Cosmetic surgery (surgery performed to alter or            • Acupuncture
   reshape normal structures of the body in order to
   improve your appearance)                                   • Psychiatry Services

 • Custodial care. Some custodial care may be covered         If you have questions about what is covered or not
   under regular (fee-for-service) Medi-Cal. For            covered, please call L.A. Care.
   more information about custodial care covered
   under regular Medi-Cal, call DPSS. You can nd
   DPSS’ phone number under the “Important Phone
   Numbers” section of this handbook.
 • Experimental and investigational services. You can
   learn more about this in “IMRs for Experimental
   and Investigational erapies (IMR-EIT)” under the
   “Complaints: What should I do if I am unhappy?”
   section of this handbook.
 • Infertility
 • Immunizations (shots) for sports, work or travel
 • Personal comfort items such as a phone, television or
   guest tray when in the hospital




                                      Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731). 29
Pharmacy benefits:
How do I get prescription drugs?
    What is a pharmacy?                                           What is a formulary?
      A pharmacy is a place to get your prescriptions lled.         L.A. Care uses a list of approved drugs called a
    L.A. Care works with pharmacies in many neighbor-             “formulary.” A committee of L.A. Care doctors and
    hoods. You must get your prescribed medications (drugs)       pharmacists reviews drugs to add or remove from the
    from a pharmacy in L.A. Care’s network. A “network”           formulary every three (3) months.
    is all of the pharmacies that work with L.A. Care. A            Drugs can be added to the formulary when they are
    pharmacy list is in the provider directory provided to        all of the following:
    you with this handbook. Or you can call L.A. Care at
    1-888-839-9909 for pharmacies in your neighborhood.             • Approved by the Food and Drug Administration
                                                                      (FDA)
                                                                    • Generally accepted to be safe and e ective
    How to get a prescription lled
      1. Choose a pharmacy that works with L.A. Care.               • Cost e ective

      2. Bring your prescription to the pharmacy.                   Your doctor usually prescribes drugs from the for-
                                                                  mulary. Your doctor will only prescribe a drug based
      3. Show the pharmacy your L.A. Care ID card.                on your health status. Just because a drug is on the
                                                                  formulary does not mean a doctor will prescribe to
      4. Make sure your pharmacy knows about all                  you. Your doctor may not believe you need it.
         medications you are taking and/or any allergies
         you have to any medicine.                                  You may call L.A. Care to ask for a copy of the
                                                                  formulary in your language, large print, Braille, audio,
      You should not be asked to pay for covered                  or alternate format. You may also call L.A. Care for a list
    prescription drugs. Call L.A. Care if a pharmacy              that compares all health plan partner formularies.
    asks you to pay.

                                                                  Drugs not on the formulary
    Prescription re lls                                             Sometimes, your doctor may need to prescribe a drug
      If you are re lling a prescription you already have, go     that is not on the formulary. Your doctor must call to get
    to a pharmacy listed in L.A. Care’s provider directory.       an okay from L.A. Care.
    Also, you may be able to receive a 90-day supply of             To decide if this drug will be covered, L.A. Care may
    maintenance medications at most local pharmacies.             ask your PCP doctor or the pharmacist (or both) for
    Maintenance medications are drugs that you need               more information. Within 24 hours after getting this
    to take for a long time, such as pills for high blood         information, L.A. Care will tell your PCP doctor or the
    pressure or diabetes. Please ask your doctor to write a       pharmacist if the drug will be covered. Your PCP doctor
    30-day prescription supply, as well as a 90-day supply        or the pharmacist will then tell you.
    for prescription re lls to take to your local network
    pharmacy for your maintenance medication(s).                    If the drug is approved, you can get the drug at a
                                                                  pharmacy that works with L.A. Care. If the drug is not
                                                                  approved, you have the right to appeal the decision. An


30 Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
                                                                              2010–2011 Medi-Cal Member Handbook




“appeal” is when you want a decision to be reviewed.            investigational drug, you have the right to request an
You can learn about this in the “Complaints: What               Independent Medical Review (IMR). You can learn
should I do if I am unhappy?” section of this handbook.         more about this in the “Complaints: What should I
                                                                do if I am unhappy?” section of this handbook.
                                                              • Cosmetic drugs, except as prescribed for medically
What drugs are covered?                                         necessary conditions
  You can get the following drugs and other items when        • Dietary or nutritional products, except when medically
they are prescribed by your doctor and are medically            necessary or for the treatment of Phenylketonuria
necessary:
                                                              • Any injectable drug that is not medically necessary
 • Prescription drugs listed on the L.A. Care formulary         and not prescribed by a doctor
 • Prescription drugs you get from a pharmacy not in          • Appetite suppressants, except as medically necessary
   L.A. Care’s network when you have an emergency               for morbid obesity
 • Non-prescription drugs or over-the-counter drugs           • Compounded medications with formulary alternatives
   (such as cough syrups, cough drops or aspirin) listed        or those with no FDA-approved indications
   on the L.A. Care formulary
                                                              • Replacement of lost or destroyed drugs no more
 • Diabetic supplies: insulin, insulin syringes, glucose        than two (2) times each calendar year (from January
   test strips, lancets and lancet puncture devices, pen
                                                                to December).
   delivery systems, blood glucose monitors (including
   monitors for the visually impaired) and ketone urine
   testing strips                                           Emergency contraception ("Plan B")
 • FDA-approved birth control devices, birth control          You may get emergency contraceptive drugs from:
   pills, diaphragms, condoms and contraceptive jellies
   on the L.A. Care formulary                                 • Your doctor
 • Emergency contraception                                    • A pharmacy with a prescription from your doctor, if
 • EpiPens, ana-kits, peak ow meters and spacers                you are younger than 17 years of age
                                                              • A pharmacy without a prescription if you are 17
                                                                years of age or older
What drugs are not covered?
 • Drugs from a non-network pharmacy, except drugs            • A pharmacy not in your health plan’s network. If this
   needed because of an emergency or out-of-area care           is the case, you may be asked to pay for the service.
                                                                Your health plan will reimburse you for this cost.
 • Non-formulary drugs, except with an okay from
   L.A. Care                                                  • A local family planning clinic
 • Drugs that are experimental or investigational in         Call L.A. Care for a list of pharmacies that provide
   nature, except in certain cases of terminal illness.     emergency contraceptive drugs.
   If you have been denied an experimental or


                                                                                                               >>
                                      Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731). 31
    Prescription authorization process for
    emergencies or urgent circumstances
      Your pharmacist is authorized to dispense a 72-hour
    supply of medication to you if you are out of medication
    after an emergency room visit that did not result in
    hospitalization and you need to ll an emergency
    prescription. Your pharmacist is also authorized to
    dispense a 72-hour supply of medication to you if you
    need the medication to avoid interruption of your current
    or prescribed drug therapy in an emergency situation.


    Medicare Part D: Prescription drug
    coverage for bene ciaries who get
    both Medicare and Medi-Cal
      Medicare administers a federal prescription drug
    program called Medicare Part D. If you are a Medi-
    Cal bene ciary with Medicare, you will get most of
    your prescription drugs from Medicare. ere are some
    prescription drugs that are not covered by Medicare but
    that you can get through Medi-Cal. However, if you have
    Medicare Part D coverage with another health plan, your
    pharmacy will not be able to ll your Medicare Part D
    prescriptions with your L.A. Care Medi-Cal. Please contact
    your Medicare Part D Plan.
      Please call L.A. Care for more information. To nd out
    more about Medicare Part D and to choose a Medicare
    Prescription Drug Plan, call Medicare at 1-800-633-4227
    or go to www.medicare.gov on the Internet.




32 Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
Emergency care:
How do I get care in an emergency?
     ere is a di erence between needing care urgently and       Emergency services and care include ambulance,
an emergency. Urgent care is when a condition, illness        medical screening, examination and evaluation by a
or injury is not life-threatening, but needs medical care     doctor or other medical personnel. Emergency services
right away. Many of L.A. Care’s doctors have urgent           include both physical and psychiatric emergency
care hours in the evening and on weekends.                    conditions, as well as active labor.
                                                              Examples of emergencies include but are not limited to:
How to get urgent care                                          • Having trouble breathing
  1. Call your PCP doctor. You may speak to an                  • Seizures (convulsions)
     operator who answers calls for your PCP doctor’s           • Lots of bleeding
     o ce when closed.                                          • Unconsciousness/blackouts (when you can’t wake up)
  2. Ask to speak to your PCP doctor or the doctor on           • Lots of pain (including chest pain)
     call. Another doctor may answer your call if your          • Swallowing of poison or medicine overdose
     PCP doctor is not available. A doctor is available
     by phone 24 hours a day, seven (7) days a week,            • Active labor
     and also on weekends and holidays.                         • Broken bones

  3. Tell them about your condition and follow their            • Head injury
     instructions.                                              • Eye injury

  You may receive same-day urgent care services. It             Examples of psychiatric emergency medical conditions
should not take longer than 48 hours from the time you        include but are not limited to:
call to request an appointment to get urgent care services      •     oughts or actions about hurting yourself or
from your PCP doctor. If you are outside of Los Angeles             someone else
County, you do not need to call your PCP doctor or get
prior authorization before getting urgent care services.        • Unable to care for yourself, such as being unable
Be sure to let your PCP doctor know about this care. You          to feed, shelter or dress yourself due to a mental
may need follow-up care from your PCP doctor.                     disorder
                                                                If you think you have a health emergency, call 911.
What is emergency care?                                       You are not required to call your doctor before you
                                                              go to the emergency room. Do not use the emergency
  Emergency services are covered anywhere–24 hours a          room for routine (regular) health care.
day, seven (7) days a week. Emergency care is a service a
member reasonably believes is necessary to stop or relieve:
  • Serious illnesses or symptoms                             What to do in an emergency
                                                                Call 911 or go to the nearest emergency room if
  • Injuries or conditions requiring immediate diagnosis
                                                              you have an emergency. Emergency care is covered at
    and treatment
                                                              all times and in all places.

                                                                                                                  >>
                                        Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731). 33
    Outside of Los Angeles County?                                How to get emergency transportation
      If you have an emergency when you are not in                  Call 911 if you have an emergency. Ambulances for
    Los Angeles County, you can get emergency services at         emergencies are paid for by L.A. Care as long as you had
    the nearest emergency facility. Emergency services do         a reasonable belief that an emergency condition existed
    not require a referral or okay from your PCP doctor.          at the time of the service.
      If you are admitted to a hospital not in L.A. Care’s
    network or to a hospital your PCP doctor or other provider
    does not work at, L.A. Care has the right to move you to      Not sure you have an emergency?
    a network hospital as soon as it is medically safe.             If you are not sure, call your PCP doctor. Do what your
      You may need hospital care after an emergency               PCP doctor tells you to do. Non-emergency problems
    to stabilize your condition.         is is called post-       may include, but are not be limited to, the following:
    stabilization care. If you do, the hospital will call         earaches, colds, the u and sore throats. Do not call 911
    L.A. Care to ask for an okay.        e hospital may ask       for non-emergency problems. Call your PCP doctor.
    you for your health plan's name and phone number.
    Show the hospital your L.A. Care ID card. If you don’t
    have your ID card, tell them to call L.A. Care.
      Your PCP doctor must provide follow-up care when
    you leave the hospital.


    What to do after an emergency
      1. Call L.A. Care within 24 hours of receiving
         emergency care or as soon as you can.
      2. Follow the instructions of the emergency room
         doctor.
      3. Call you PCP doctor to make an appointment for
         follow-up care.




34 Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
Help in another language
and for people with disabilities:
How can I get help?
Information in other languages                                 You should not use children or family members as
                                                             interpreters. Call L.A. Care or your doctor if you need
  You have the right to receive all member materials
                                                             interpreting services. We will work with you and your
in any of the following languages: Spanish, Armenian,
                                                             PCP doctor to make sure you can have services in a
Chinese, Farsi, Khmer, Korean, Tagalog, Russian,
                                                             language you understand.
Vietnamese and English.
                                                               California Relay Service.      e California Relay
                                                             Service (CRS) helps a person using a TTY to
Interpreters for members who don’t speak                     communicate by phone with a person who does not
English or are hearing or speech impaired                    use a TTY. CRS can also help a non-TTY user call a
  We know doctors and other providers must understand        TTY user. Trained operators take phone calls and help
you so that you can get the health care services you         hearing people and non-hearing people communicate.
need. Laws such as the Civil Rights Act of 1964 and the        Statewide access for voice or TTY/TDD is 1-888-
Americans with Disabilities Act (ADA) of 1990 protect        877-5379 voice (SPRINT) or 1-800-735-2922 voice
you if you do not speak English or have a disability and     (MCI). Members and providers can also dial 711 on
need help communicating with your doctor.                    their phones to call the California Relay Service directly.
  Your doctor’s o ce, clinic or hospital can’t deny
services to you because you do not speak English or
have a disability. You have the right to free interpreting
                                                             Protection for people with disabilities
services including American Sign Language interpreters           e Americans with Disabilities Act (ADA) of
when getting health care service or other services that      1990 is a law that protects people with disabilities
are paid for by your health plan, including after-hours      from being treated unfairly. A disability is a physical
interpreting services.                                       or mental condition that totally or seriously limits a
                                                             person’s ability in at least one major life activity. is
  An interpreter is a person who helps you understand
                                                             law protects people who:
what is being said by the person who is giving you care.
An interpreter also tells the other person what you said,      • Are any age, including seniors (65 years of age or
but in the language that person understands. is allows           older), who have disabilities
people who speak di erent languages to talk with and
                                                               • Have disabilities such as hearing, speech or vision
understand each other. is is also more private because
                                                                 loss, developmental disabilities and other types of
you are not telling your child, family member or friend
                                                                 disabilities
to interpret for you.
                                                               • May not look like they have a disability or had a
                                                                 disability in the past
If you need interpreting services
  Interpreting services in your language, including
American Sign Language, are free–24 hours a day, seven
(7) days a week.
                                                                                                                  >>
                                       Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731). 35
         e ADA law makes sure there are equal chances for
    people with disabilities in employment and in state and
    local government services, including health care.
      A doctor’s o ce, clinic or hospital can’t deny you
    services because you are hearing impaired or have other
    disabilities. Call your health plan right away if you don’t
    get the services you need or if services are hard to get.
       Here are some telephone numbers that can help you
    if you have a disability or want more information about
    the Americans with Disabilities Act (ADA):
      ADA Information Line:
      1-800-514-0301 (Voice)
      1-800-514-0383 (TDD)


    Remember: Tell your doctor’s o ce if you need an
    interpreter, require extra time during your visit, or
    need help because of a disability.


    Complaints
      You can also le a complaint if:
      • You can’t get an interpreter
      • You couldn’t get information in your language
      • You feel that you were denied services because of a
        disability
      You can learn more about this in the “Complaints:
    What should I do if I am unhappy?” section of this
    handbook.




36 Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
Complaints:
What should I do if I am unhappy?
  If you are not happy, are having problems, or have         How to le a grievance
questions about the service or care given to you, you have
                                                               You have many ways to le a grievance. You can do
the option of letting your PCP doctor know. Your PCP
                                                             any of the following:
doctor will be able to help you or answer your questions.
                                                                 • Fill out a grievance form at your doctor’s o ce.
   At any time, you or your Member Representative may
                                                                   Your PCP doctor will have grievance forms
  le a grievance (or complaint) with L.A. Care. A Member
                                                                   available in his or her o ce.
Representative is a person or persons appointed by the
member, via written statement, to represent them in the          • Write, visit or call L.A. Care.
State of California as a health care proxy, trustee named           L.A. Care Health Plan
in a durable power of attorney or court appointed                   Member Services Department
guardian. Also known as a Personal Representative(s), a             555 West Fifth Street
Member Representative can be a spouse, relative, friend,            Los Angeles, CA 90013
advocate, doctor, practitioner or someone designated as             1-888-839-9909
a representative by the member under Durable Power of               1-213-438-5748 (fax)
Attorney, or as an Executor/Administrator of Estate or as
a legal/court-appointed guardian.                                • You may also le a grievance online through
                                                                   L.A. Care’s Web site at www.lacare.org. Call
  L.A. Care can’t take away your health care bene ts or            L.A. Care to get a grievance form in another
do anything to hurt you in any way if you le a grievance           language or format (Braille, large print or other
or use any of your privacy rights in this handbook.                alternative formats).
                                                               If you receive a Notice of Action from L.A. Care, you
What is a grievance?                                         have three (3) options on how to le a grievance:
  A grievance is a complaint that is recorded and tracked.       • You have 90 calendar days from the date on the
You have the right to le a grievance. You have two (2)             Notice of Action to le a grievance with L.A. Care.
time limits to le a grievance:
                                                                 • You may request a State Hearing regarding your
  • If you receive a Notice of Action from L.A. Care,              Notice of Action from the Department of Social
    then you have 90 calendar days from the date on                Services (DSS) within 90 calendar days.
    the notice to le a grievance with L.A. Care. A
    Notice of Action is a formal letter telling you that a       • You may request an Independent Medical Review
    medical service has been denied, deferred, modi ed             (IMR) regarding your Notice of Action from the
    or terminated. If you receive a Notice of Action it            Department of Managed Health Care (DMHC).
    will tell you in the section about “Your Rights” that
                                                                   º Youcan also ask for a State Fair Hearing at the
    you have 90 calendar days to le a grievance.
                                                                     same time you are ling your grievance to a
  • You can also le a grievance that is not about a                  Notice of Action.
    Notice of Action. You must le your grievance
    within 180 calendar days from the day you became           L.A. Care can help you ll out the grievance form over
    unhappy with the service or care given to you by         the phone or in person. Or we can send you a grievance
    either your PCP doctor, specialist, medical group,       form to ll out and send back to us.
    hospital, pharmacy or L.A. Care.
                                                                                                                 >>
                                       Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731). 37
      Within ve (5) calendar days of getting your                 How to le a grievance for urgent cases
    grievance, L.A. Care will send you a letter to let you
                                                                    Examples of urgent cases include:
    know that we have your grievance and are working
    on it. en, within 30 calendar days of getting your             •   Severe pain
    grievance, L.A. Care will send you a letter explaining         •   Potential loss of life, limb or major bodily function
    how the grievance was resolved.                                •   Immediate and serious decline of your health
       Filing a grievance or requesting a State Fair Hearing
    does not a ect your medical bene ts. If you le a                In urgent cases, you can request an expedited (or
    grievance or request a State Fair Hearing, you may be         quick) review of your grievance. You may present
    able to continue a medical service while the grievance        evidence to support your grievance; however, the time
    is being resolved. To nd out more about continuing a          available to present this evidence is limited. A decision
    medical service, call L.A. Care.                              will be made by L.A. Care within three calendar days
                                                                  (or 72 hours) from the day your grievance was received.
      Grievances for Medi-Cal eligibility are not
    processed by L.A. Care. To le a grievance about                 You have the right to request an expedited State
    Medi-Cal eligibility, call DPSS. You can nd                   Fair Hearing. You can request an expedited State Fair
    DPSS' phone number under the “Important Phone                 Hearing and le a grievance with L.A. Care. For more
    Numbers” section of this handbook.                            information about State Fair Hearings, go to the “State
                                                                  Fair Hearing” section of this handbook.
                                                                    You have the right to le an urgent grievance with
    If you don’t agree with the outcome                           DMHC without ling a grievance with L.A. Care. For
    of your grievance                                             information on how to le a grievance with DMHC,
       If you don’t agree with the decision made on your          go to the “Contacting to the Department of Managed
    grievance, you may request a State Fair Hearing and           Health Care (DMHC)” section of this handbook.
      le a grievance with the Department of Managed
    Health Care (DMHC). You can also le a grievance
    with the DMHC if you do not hear from L.A. Care               If you don’t agree with the outcome
    within 30 calendar days. You may also request an              of your grievance for urgent cases
    Independent Medical Review (IMR) with DMHC.                     If you don’t agree with the decision made on your
    For more information about State Fair Hearings, go            grievance, you may request a State Fair Hearing and le
    to the “State Fair Hearing” section of this handbook.         a grievance with the Department of Managed Health
    For information on how to le a grievance with                 Care (DMHC). You can also le a grievance with
    DMHC, go to the “Contacting the Department of                 DMHC if you do not hear from L.A. Care within 30
    Managed Health Care (DMHC)” section of this                   calendar days. You may also request an Independent
    handbook. For information on how to request an                Medical Review (IMR) with DMHC. For more
    IMR, go to the “Independent Medical Review”                   information about State Fair Hearings, go to the “State
    section of this handbook.                                     Fair Hearing” section of this handbook. For information
                                                                  on how to le a grievance with DMHC, go to the
                                                                  “Contacting the Department of Managed Health Care
                                                                  (DMHC)” section of this handbook. For information
                                                                  on how to request an IMR, go to the “Independent
                                                                  Medical Review” section of this handbook.




38 Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
                                                                                  2010–2011 Medi-Cal Member Handbook


Independent Medical Review                                      You must rst go through the L.A. Care grievance
                                                              process, before applying for an IMR. In special
  You may request an Independent Medical Review
                                                              cases, the DMHC can not require you to follow the
(IMR) from DMHC. You have up to six (6) months
                                                              L.A. Care grievance process before ling an IMR. In
from the date you get a Notice of Action from L.A. Care
                                                              urgent circumstances or cases of emergency, you are
to le an IMR. A Notice of Action lets you know about
                                                              not required to participate in the L.A. Care expedited
an action by L.A. Care to delay, deny, modify or
                                                              grievance process for more than three (3) days before
terminate a health care service or bene t. You will
                                                               ling an IMR.
receive information on how to le an IMR with your
notice. You may reach DMHC toll-free at 1-888-HMO-                 e dispute will be submitted to a DMHC medical
2219 or 1-888-466-2219.                                       specialist if it is eligible for an IMR. e specialist will
                                                              make an independent decision on whether or not the
  You can still request a State Fair Hearing if you request
                                                              care is medically necessary. You will receive a copy of
an IMR. However, you will not be able to use the IMR
                                                              the IMR decision from DMHC. If it is decided that the
process if you have requested a State Fair Hearing. Go
                                                              service is medically necessary, L.A. Care will provide
to the “State Fair Hearing” section of this handbook to
                                                              the health care service.
 nd out how to le a grievance.
                                                              Non-urgent cases
     ere are no fees for an IMR. You have the right
to provide information to support your request for              For non-urgent cases, the IMR decision must be made
an IMR. After the IMR application is submitted, a             within 30 calendar days. e 30 calendar day period
decision not to take part in the IMR process can cause        starts when your application and all documents are
you to lose certain legal rights to pursue legal action       received by DMHC.
against the plan.
                                                              Urgent cases
When to le an Independent Medical Review (IMR)                  If your grievance is urgent and requires fast review,
  You may le an IMR if you meet the following                 you can bring it to DMHC’s attention right away. You
requirements:                                                 will not be required to participate in the health plan
                                                              grievance process.
 •   Your doctor says you need a health care service
     because it is medically necessary, but it was denied,      For urgent cases, the IMR decision must be made
     or                                                       within three (3) calendar days from the time your
                                                              information is received.
 •   You received urgent or emergency services
     determined to be necessary, but they were denied; or       Examples of urgent cases include:
 •   You have seen a network doctor for the diagnosis           •   Severe pain
     or treatment of the medical condition, even if the         •   Potential loss of life, limb or major bodily function
     health care services were not recommended.
                                                                •   Immediate and serious decline of your health
 •      e disputed health care service is denied, changed
     or delayed by L.A. Care based in whole or in part
     on a decision that the health care service is not        IMRs for Experimental and
     medically necessary; and                                 Investigational Therapies (IMR-EIT)
 •   You have led a grievance with L.A. Care and the            You can request an IMR-EIT through the DMHC
     health care service is still denied, changed, delayed    when a medical service, drug or equipment is denied
     or the grievance remains unresolved after 30             because it is experimental or investigational in nature.
     calendar days.                                           L.A. Care will notify you in writing that you can request


                                                                                                                    >>
                                        Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731). 39
    an IMR-EIT within ve (5) days of the decision to deny          Contacting the California Department
    coverage. You have up to six (6) months from the date of       of Managed Health Care (DMHC)
    denial to le an IMR-EIT. You can give information to
                                                                        e California Department of Managed Health
    the IMR-EIT panel. e IMR-EIT panel will give you
                                                                   Care (DMHC) is responsible for regulating health
    a written decision within 30 calendar days from when
                                                                   care service plans. If you have a grievance against your
    your request was received. If your doctor thinks that
                                                                   health plan, you should rst telephone your health plan
    the proposed therapy will be less e ective if delayed, the
                                                                   at 1-888-839-9909 and use your health plan’s grievance
    decision will be made within seven (7) days of the request
                                                                   process before contacting the department. Utilizing this
    for an expedited (or quick) review. In urgent cases the
                                                                   grievance procedure does not prohibit any potential
    IMR-EIT panel will give you a decision within three (3)
                                                                   legal rights or remedies that may be available to you.
    business days from the time your information is received.
                                                                     If you need help with a grievance involving an
    You can le an IMR-EIT if you meet the following
                                                                   emergency, a grievance that has not been satisfactorily
    requirements:
                                                                   resolved by your health plan, or a grievance that has
      • You have a very serious condition that is life-            remained unresolved for more than 30 days, you may
        threatening or debilitating (for example, terminal         call the department for assistance. You may also be
        cancer).                                                   eligible for an Independent Medical Review (IMR).
      • Your doctor must certify that:                             If you are eligible for an IMR, the IMR process will
                                                                   provide an impartial review of medical decisions made
          º     e standard treatments were not or will not be
                                                                   by a health plan related to the medical necessity of a
              e ective, or
                                                                   proposed service or treatment, coverage decisions for
          º      e standard treatments were not medically          treatments that are experimental or investigational in
              appropriate, or                                      nature, and payment disputes for emergency or urgent
          º     e proposed treatment will be the most e ective.    medical services.
      • Your doctor certi es in writing that:                           e department also has a toll-free telephone number
          º A drug, device, procedure or other therapy is likely
                                                                   (1-888-HMO-2219) and a TDD line (1-877-688-9891)
              to work better than the standard treatment.          for the hearing and speech impaired. e department’s
                                                                   Web site, (www.hmohelp.ca.gov) has complaint forms,
          º Based on two (2) medical and scienti  c documents,     IMR application forms and instructions online.
              the recommended treatment is likely to work
              better than the standard treatment.
      • You have been denied a drug, equipment, procedure          State Fair Hearing
        or other therapy recommended or requested by your             A State Fair Hearing is another way you can le a
        doctor.                                                    grievance. You can present your case directly to the State
      •     e treatment would normally be covered as a             of California. All L.A. Care members have the right to
          bene t, but L.A. Care has determined that it is          ask for a State Fair Hearing at any time within 90 days
          experimental or investigational in nature.               of the incident. You can still request a State Fair Hearing
      To nd out more, get help with the IMR or IMR-                if you request an Independent Medical Review (IMR).
    EIT process, or ask for an application form, please            However, you will not be able to use the IMR process
    call L.A. Care.                                                if you have requested a State Fair Hearing. Go to the
                                                                   “IMR” section to nd out more.
      You do not need to participate in L.A. Care’s grievance
    process before asking for an IMR of a decision to deny           You may ask for a State Fair Hearing by calling
    coverage on the basis that the treatment is experimental       toll-free 1-800-952-5253 (English and Spanish), or by
    or investigational in nature.                                  writing to:



40 Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
                                                                                2010–2011 Medi-Cal Member Handbook


  California Department of Social Services                    Arbitration: Solving problems
  State Hearings Division                                     without going to court
  P.O. Box 944243, MS 19-37
                                                                L.A. Care knows that some members wish to get health
  Sacramento, CA 94244-2430
                                                              care services from a health plan that uses arbitration.
                                                              When you choose arbitration, you give up the right to
Expedited State Hearing                                       have your problem settled by a judge or jury. Many view
                                                              arbitration as cheaper, quicker and better than the courts.
  In cases of health services denials, you or your provider
can ask for a faster decision through an Expedited State        During arbitration, a neutral (fair and unbiased)
Hearing if your life, health or ability to attain, maintain   arbitrator will listen to everyone and make a decision.
or regain maximum function could be in serious danger         You and your doctor or health plan must follow
by going through a standard State Fair Hearing. An            that decision. at is why the process is often called
emancipated minor, a parent on behalf of his/her minor        “binding” arbitration.
child, and a duly-appointed guardian or conservator of             e party that does not win will pay for the costs
a member can also request an Expedited State Hearing.         unless the arbitrator decides otherwise. at being said,
Requests for Expedited State Hearings should be               the winning party will never be responsible for more than
directed to:                                                  legal fees and costs or more than one-half of the costs.
  Expedited Hearings Unit                                       L.A. Care can pay some or all of the fees and expenses of
  California Department of Social Services                    the arbitrator in cases of great nancial hardship. Please
  State Hearings Division                                     contact L.A. Care for information and an application.
  744 P Street, MS 19-65                                      Arbitration does not apply to claims or disputes about
  Sacramento, CA 95814                                        alleged medical malpractice.
  Phone: 1-800-952-5253
  Fax: 916-229-4267
                                                              Voluntary mediation
  You can also call the DPSS Los Angeles County o ce
                                                                You can ask for mediation to resolve a grievance. An
toll-free at 1-877-481-1044. If you do not speak English,
                                                              independent third person will resolve your grievance. is
please stay on the line and ask for the language you
                                                              person is not related to L.A. Care. You and L.A. Care
speak. DPSS has sta members who speak Armenian,
                                                              must agree to use the mediation process. You may ask
Chinese, Russian, Spanish, Tagalog and Vietnamese.
                                                              for mediation, but L.A. Care can decline your request.
You can also write to:
                                                              You can still le a grievance with DMHC even if you use
  Department of Public Social Services (DPSS)                 mediation. You do not need to participate in L.A. Care’s
  State Fair Hearings Section                                 mediation process for any longer than 30 days prior to
  P.O. Box 10280                                              submitting a grievance to DMHC. To request mediation,
  Glendale, CA 91209                                          call L.A. Care.

Ombudsman O ce
  You can call the Ombudsman O ce of the California
Department of Health Care Services (DHCS) for help
with grievances. e Ombudsman O ce was created
to help Medi-Cal bene ciaries fully use their rights and
responsibilities as members of a managed care plan. To
  nd out more, call toll-free 1-888-452-8609.


                                                                                                                   >>
                                        Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731). 41
Confidentiality:
What are my privacy rights?
      You have the right to keep your medical records             of password protection and software technology.
    con dential.     at means that only people who need           L.A. Care’s does not give out health information to
    to see your records in order for you to get good health       anyone or any group that does not have a right to the
    care will see them. You can request a copy of our Notice      information by law.
    of Privacy Practices (NOPP). Just call L.A. Care. An            L.A. Care need information about you so that we
    NOPP is provided to you in this handbook. If you would        can give you good health care services.       e routine
    like another copy of this information, call L.A. Care.        collection, use and disclosure of your protected health
       e NOPP is also available on L.A. Care’s Web site at        information and other kinds of private information
    www.lacare.org.                                               include:
                                                                    • Name
    Health information privacy                                      • Gender
      We want you to know the things that L.A. Care does            • Date of birth
    to keep health information about you and your family            • Language you speak
    private. To keep health information about you and your
    family private, we:                                             • Home address
      • Handle health information the same way, every time          • Home or work telephone number
                                                                    • Employer and occupation
      • Review the way health information is handled
                                                                    • Whether you are married or single
      • Follow all laws about the privacy and con dentiality        • Health history
        of health information
                                                                    L.A. Care does not have complete copies of your
      All L.A. Care sta with access to your health                medical records. We may get this information from you
    information are trained on privacy and information            or any of these other sources:
    security laws.    ey also follow L.A. Care rules on
    how to take care of your health information so it stays         • A parent, guardian or conservator
    private. ey follow L.A. Care policies and procedures            • Another health plan
    to protect conversations about you as well as written           • Your doctor
    and electronic documents that contain protected health
    information about you. Employees even sign a note               • Your application for the health care program
    that promises they will keep all health information             • Your health records
    private. For example, employees are not allowed to              •     e California Department of Health Care
    speak about your information in elevators or hallways.              Services
    Employees must also protect any written or electronic
    documents containing your health information across             Before L.A. Care gives your health information to
    the organization. Employees have access only to               someone else or another group, we need your approval in
    the amount of information needed to do their job.             writing. However, there are times when we don’t have to
    L.A. Care’s computer systems protect your electronic          get your approval in writing. is may happen when:
    health information at all times by using various levels


42 Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
                                                                               2010–2011 Medi-Cal Member Handbook




 • A court, arbitrator or similar agency needs your            You can also get more information about privacy,
   health information.                                       information security and con dentiality of your health
 • A subpoena or search warrant is requested.                information, or how to access your health information,
                                                             by visiting L.A. Care online at www.lacare.org.
 • A coroner needs your health information.
                                                               If you believe that your privacy has not been protected,
 • Your health information is needed by law.                 you have the right to complain. You can le a grievance
 • Your health information is needed for treatment,          (complaint) by contacting L.A. Care Member Services
   payment or for health care operations.                    and asking to speak with the Privacy & Information
  We may give your health information to another             Security O cer at 1-888-839-9909, or you can contact
health plan to:                                              the Department of Health Care Services (DHCS) at
                                                             1-916-255-5259, TTY at 1-877-735-2929, or the U.S.
 • Make a diagnosis or give treatment
                                                             O ce of Civil Rights 1-866-627-7748, TTY 1-866-
 • Make a payment for your health care                       788-4989. ese phone numbers are available to you
 • Review the quality of your health care                    24 hours a day, seven (7) days a week. All calls are
                                                             con dential. All calls are free except for 1-916-255-5259.
  Sometimes, we may also give your health information
to:
 • Groups who license health care providers                  Protect yourself from identity theft
 • Public agencies                                             Here are some steps you can take to help prevent your
 • Investigators                                             personal information from being stolen, also known as
                                                             identity theft:
 • Probate courts
                                                               • Protect your member ID card like you protect your
 • Organ donation groups
                                                                 bank or credit cards.
 • Federal or state agencies as required by law
                                                               • Take your ID card to your doctor’s appointment.
 • Disease management programs                                   Avoid speaking about your membership information,
 • Other health plans or providers involved in your              personal facts or saying your social security number
   care                                                          out loud or to other people.
  Please note that we won’t tell anyone the results from       • Don’t give out your personal information unless it
any genetic testing.                                             is asked for by your doctor, clinic, hospital, other
                                                                 medical sta or health plan.
  If you have any questions, would like a printed copy of
the NOPP mailed to you, would like to pick up a paper
copy of the NOPP, or would like to know more about
the privacy, information security and con dentiality of
your health information, please call L.A. Care’s Member
Services to reach the Privacy & Information Security
O cer at 1-888-839-9909.




                                       Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731). 43
Fraud, waste & abuse:
How to identify and report it
    Fraud                                                         Services Fraud & Abuse Hotline at 1-800-822-6222
                                                                  or the Department of Justice O ce of the Attorney
      Fraud includes, but is not limited to, using someone
                                                                  General Bureau of Medi-Cal Fraud & Elder Abuse at
    else’s medical bene ts for your health care services,
                                                                  1-800-722-0432. Your call is free and con dential.
    using someone else’s social security number to qualify
    for government assistance or billing from the doctor for
    services that did not occur. If you commit fraud you          Why should you care about
    may lose your Medi-Cal coverage.                              fraud, waste and abuse?
                                                                    Health care fraud, waste and abuse are serious issues.
    Waste                                                         Fraudulently received bene ts or services impact the
      Waste is the planned use, throwing away or spending         cost of your health care services. e cost of health care
    of health care or government resources in an unwise and       impacts the bene ts available to you.
    wrong manner. Examples of waste include:
      • Prescribing more medication than is medically             Preventing health care fraud
        necessary                                                   Here are a few helpful tips on how you can help
      • Providing more health care services than is               prevent health care fraud:
        medically necessary                                         • Do not give your ID card or ID card number to
                                                                      anyone except your doctor, clinic, hospital, health
                                                                      care provider or health plan.
    Abuse
                                                                    • Do not let anyone borrow your ID card.
      Abuse is the planned misuse of health care or
    government resources. Examples of abuse include:                • Never loan your social security card to anyone.
      • Requesting and obtaining medications or medical             • Never sign a blank insurance claim form.
        equipment you do not need to use for your bene t
                                                                    • Beware of anyone who o ers you free medical
      • Billing from the doctor for services that did not             services in exchange for your ID card. You should
        occur                                                         never give away your ID card to anyone in exchange
                                                                      for free medical services.

    How to report fraud, waste and abuse                            • If it sounds too good to be true, it probably is.
       If you suspect someone of using your information or            Be careful about accepting medical services in
    committing fraud, waste or abuse, please call L.A. Care’s         addition to Medi-Cal when you are told they will
    Compliance Helpline at 1-800-400-4889. is number                  be free of charge.
    is available 24 hours a day, seven (7) days a week.
      You can also call L.A. Care’s Member Services and
    ask to speak with the Compliance O cer at 1-888-839-
    9909, or you could call the Department of Health Care


44 Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
Medi-Cal: How can I make
sure I don’t lose my coverage?
Keeping your Medi-Cal eligibility                            Two types of Medi-Cal
  To stay in Medi-Cal, you must be eligible for it.              ere are two types of Medi-Cal in Los Angeles
“Eligible” means that a person meets certain requirements    County: “fee-for-service” and “managed care.” In
to receive bene ts from programs like Medi-Cal.              Los Angeles County, most Medi-Cal members are in
                                                             managed care. L.A. Care is a managed care health plan.
If you lose Medi-Cal eligibility, you will not be able         “Managed care” is when your health care is managed
to keep your Medi-Cal bene ts with L.A. Care.                and coordinated by a health plan and a PCP doctor.
                                                                 is makes it easier for you to get the care you need.
  Be sure to ll out and return any information requested     It is L.A. Care’s job to make sure you get the care you
before the due date on the letter or form. If you have       need. For example, if you need to see a specialist, it is
any questions about your Medi-Cal eligibility, call your     your PCP doctor’s and our job to nd a specialist who
eligibility worker or the Department of Public and           will see you.
Social Services (DPSS) toll-free at 1-877-481-1044.            In “fee-for-service” Medi-Cal, you are not in a health
                                                             plan and must nd doctors and other providers who
                                                             will accept payment from Medi-Cal. No one manages
If you move, you must tell us!                               or coordinates your care for you. No one helps you nd
  Don’t lose your Medi-Cal coverage if you move! DPSS        doctors and providers who will accept payment from
must have your address so they can send you mail to          Medi-Cal.
renew and stay eligible.                                         is section explains why you are in managed care
  If you move but still live in Los Angeles County,          and the reasons why you can or can’t be enrolled in
please:                                                      or disenrolled from a managed care health plan. To
                                                             “enroll” means you become a member of a health plan.
  1. Call your eligibility worker at DPSS right away at
                                                             To “disenroll” means you leave a health plan and are no
     1-877-481-1044.
                                                             longer a member.
  2. Call L.A. Care. We need to know your new address
     and phone number.
                                                             Mandatory Medi-Cal managed care members
   If you move outside of Los Angeles County but still
                                                                 e California Department of Health Care Services
live in California, call your eligibility worker at DPSS
                                                             (DHCS) is in charge of Medi-Cal. DHCS says that in
right away toll-free at 1-877-481-1044. Your eligibility
                                                             Los Angeles County, most Medi-Cal members must
worker can help you nd out what Medi-Cal services are
                                                             enroll in a health plan and be in managed care. Members
available in your new community.
                                                             who must enroll in a health plan are called “mandatory
                                                             members.”




                                                                                                                 >>
                                       Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731). 45
     A mandatory member may disenroll from Medi-Cal               Voluntary disenrollment
    managed care only if the member:
                                                                    To “disenroll” means you leave a health plan and are
      • Has a complex medical condition (such as HIV/             no longer a member. To disenroll from L.A. Care, call
        AIDS or cancer), and                                      Health Care Options at 1-800-430-4263. Health Care
                                                                  Options enrolls or disenrolls Medi-Cal bene ciaries in or
      • Has been in Medi-Cal managed care fewer than 90
                                                                  out of a Medi-Cal managed care health plan. ey will
        days, and
                                                                  send you a disenrollment form. Your membership will
      • Is being treated by a doctor who does not work with       end on the last day of the month in which Health Care
        any Medi-Cal managed care health plan.                    Options approves your request. Disenrollment takes 15
                                                                  to 45 days. You must continue to receive services through
      Otherwise, the member must choose a health plan like        L.A. Care until you are disenrolled from L.A. Care.
    L.A. Care. For help with fee-for-service bene ts outside
                                                                   If you leave L.A. Care, you can’t stay enrolled with
    of managed care, call L.A. Care.
                                                                  L.A. Care for your Medi-Cal coverage.

    Voluntary Medi-Cal managed care members
                                                                  Involuntary disenrollments
      In Los Angeles County, some people with Medi-Cal
                                                                    You will lose managed care coverage with L.A. Care,
    can choose to enroll in a health plan. Members who
                                                                  but not necessarily your Medi-Cal bene ts, if any of the
    choose to enroll in a health plan are called “voluntary
                                                                  following happens:
    members.” A voluntary member can choose to leave
    his or her health plan and return to fee-for-service            • You move out of Los Angeles County permanently.
    Medi-Cal at any time. Voluntary members include:                • You are in a long-term care or intermediate care
      •     e disabled or elderly receiving Supplemental              facility beyond the month of admission and the
          Security Income (SSI)                                       following month.
      •     ose 65 years or older                                   • You require medical health care services not
                                                                      provided by L.A. Care (for example, some major
      • American Indians and their household, and others
                                                                      organ transplants, and chronic kidney dialysis).
        who are eligible to get services from an Indian
        Health Center or Native American Health Clinic              • You have other non-government or government-
                                                                      sponsored health coverage.
      • Children in foster care or the Adoption Assistance
        Program                                                     • You are in prison or jail.
      • Members with HIV/AIDS diagnosis                             If you are a mandatory or voluntary member, you can
                                                                  also be disenrolled from L.A. Care, even if you don’t
                                                                  want to leave, if:
                                                                    • You take part in any fraud having to do with services,
                                                                      bene ts or facilities of the plan.
                                                                    • You show an ongoing signi cant disruptive behavior
                                                                      toward other members, providers, provider sta or
                                                                      L.A. Care.
                                                                    • L.A. Care is not able, in good cause, to give health
                                                                      care services to you. L.A. Care will use their best
                                                                      e orts to provide the needed services.




46 Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
                                                                               2010–2011 Medi-Cal Member Handbook


  If you are disenrolled from L.A. Care, we will send you    Transitional Medi-Cal
a letter that says when your coverage will end and why.
                                                              Transitional Medi-Cal is also called “Medi-Cal for
You may le an appeal with the California Department
                                                             working people.” You may be able to get transitional
of Managed Health Care (DMHC) if you think that
                                                             Medi-Cal if you stop getting Medi-Cal because:
your cancellation is because of your health status or
need for services. is means you can ask DMHC to                • You started earning more money; OR
make sure we are allowed to disenroll you. You may             • Your family started receiving more child or spousal
also ask for a review from the California Department             support.
of Health Care Services (DHCS). You can learn more             For example, if you are the person in your household
about this in the “Complaints: What should I do if I am      who earns the most money, you might get transitional
unhappy?” section of this handbook. You can also call        Medi-Cal. Even if you are a caretaker relative, you
L.A. Care to nd out more.                                    might get transitional Medi-Cal if you started earning
                                                             more money or you are receiving more child or spousal
                                                             support.
Expedited disenrollment
                                                               Parents and caretaker relatives who get transitional
   L.A. Care will process an Expedited Disenrollment
                                                             Medi-Cal can get free Medi-Cal coverage for six (6) to
if we are not able to provide you with medical services
                                                             24 months. If you stopped getting Medi-Cal, you should
due to your condition or situation which is indicated
                                                             ask your eligibility worker if you qualify for transitional
in L.A. Care’s contract with the California Department
                                                             Medi-Cal. Call your eligibility worker at DPSS toll-free
of Health Care Services (DHCS). is may include a
                                                             at 1-877-481-1044. You can stay with L.A. Care if you
major organ transplant, long-term care service, Foster
                                                             are eligible for transitional Medi-Cal.
Care or Adoption Assistance Programs, or if you move
out of Los Angeles County. We will submit a disen-
rollment request to DHCS, which will make a decision
within 72 hours. When we receive the decision, we will
notify you and your PCP doctor of the e ective date of
disenrollment. Your health care for the condition will be
covered by regular Medi-Cal.




                                       Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731). 47
Getting involved:
How do I participate?
      Many L .A. Care policies are decided by                     Board of Governors meetings
    California Department of Health Services. Other
                                                                      e Board of Governors decides policies for L.A. Care.
    policies are set by L.A. Care and members like you.
                                                                  Anyone can attend these meetings. e Board of Gov-
                                                                  ernors meets on the rst ursday of each month from
                                                                  2 p.m. to 4 p.m. To nd out more call the L.A. Care
    L.A. Care Public Policy Committee
                                                                  Meeting Information Line at 213-438-5408.
       L.A. Care has a public policy committee you may
    join. is committee discusses member and health plan
    issues. To nd out more, please call L.A. Care.                Communicating policy changes
                                                                    As an L.A. Care member, you will get information
                                                                  on all policy changes that a ect your health care. All
    L.A. Care Regional Community
                                                                  important information will be included in your member
    Advisory Committees (RCAC)                                    newsletter or special mailings.
         ere are 11 L.A. Care Regional Community Advisory
    Committees (RCAC) in Los Angeles County. (RCAC
    is pronounced “rack.”)      eir purpose is to give input
    to L.A. Care that might a ect policies, procedures,
    programs and practices.
      RCAC members:
      • Talk about member issues
      • Advise the L.A. Care Board of Governors
      • Educate and empower the community on health
        care issues
      RCACs meet once a month. RCACs include
    L.A. Care members, member advocates (supporters) and
    health care providers. To nd out more about RCACs,
    call the L.A. Care Community Outreach and Educa-
    tion Department toll-free at 1-888-LA-CARE2 (1-888-
    522-2732).




48 Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
More important information:
What else do I need to know?
If you travel outside of Los Angeles County                 Third party liability
 As a member of L.A. Care, your service area is               L.A. Care will provide covered services when an injury
Los Angeles County. All locations outside of Los Angeles    or illness is caused by a third party. L.A. Care may request
County are out of your service area.                        the legal right to keep any payment or right to payment
  Routine care is not covered out of the service area.      you may have received as a result of a third party injury
Emergency and urgent care services are covered outside      or illness. Under California State Law, this is called
of Los Angeles County.                                      “asserting a lien.” e amount of this lien may include:
                                                              • Reasonable and true costs paid for health care
                                                                services given to you
How a provider gets paid                                      • An additional amount as provided under California
  Health care providers can be paid in several ways by          State Law
the health plan or medical group which they may have a        As a member, you also agree to help L.A. Care in
contract with. Providers may receive:                       recovering payments for services provided.  is may
 • A fee for each service provided                          require you to sign or provide documents needed to
 • Capitation (a at rate paid each month permember)         protect the rights of L.A. Care.
 • Provider incentives or bonuses
  Please call L.A. Care if you would like to know           Medi-Cal Estate Recovery Program
more about how your doctor is paid or about nancial              e Medi-Cal program pays for medical care for
incentives or bonuses.                                      some people whose savings and income are too low for
                                                            them to be able to pay for their own care. e cost
                                                            of a member’s medical care may have to be paid back
If you have other insurance                                 to the Medi-Cal program after the member’s death.
  Please call L.A. Care at 1-888-839-9909 to tell              is is called the Medi-Cal Estate Recovery Program.
us about any health insurance you have other than           After getting notice of the death of a member, the
L.A. Care so that we can send all bills to the correct      Department of Health Care Services (DHCS) will
place for payment.                                          decide if the cost of the member’s medical care must
                                                            be paid back. DHCS will never ask for more to be paid
                                                            back than the value of the assets owned by the member
Workers’ Compensation                                       at the time of his or her death.
  L.A. Care will not pay for work-related injuries            To learn more about the Medi-Cal Estate Recovery
covered by Workers’ Compensation. L.A. Care will            Program, write or call DHCS.
provide health care services you need while there are
                                                              Department of Health Care Services
questions about an injury being work-related. Before
                                                              Estate Recovery Section, MS 4720
L.A. Care will do this, you must agree to give L.A. Care
                                                              P.O. Box 997425
all information and documents needed to recover costs
                                                              Sacramento, CA 95899-7425
for any services provided.
                                                              1-916-650-0490
                                                              1-916-650-6584 (fax)
                                                                                                                  >>
                                      Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731). 49
    Disruption in services                                        What is an advance directive?
      L.A. Care will use its best e orts to provide services        An advance directive is a signed legal document. It
    in the event of a war, riot or other unusual event. If        allows you to select a person to make your health care
    L.A. Care is not able to provide health services, we will     choices at a time when you can’t make them yourself
    send members to the nearest hospital for emergency            (for example if you are in a coma). An advance directive
    services and pay for these services.                          must be signed when you are able to make your own
                                                                  decisions. L.A. Care will tell you about any changes to
                                                                  state law about advance directives. We will send you
    Organ donation                                                this information as soon as possible but no later than
        ere is a need for organ donors in the United States.      90 days after the date of change. Ask your doctor or call
    You can agree to donate your organs in the event of your      L.A. Care to nd out more about advance directives.
    death. e California Department of Motor Vehicles
    (DMV) will give you a donor card if you wish to become
    an organ or tissue donor. e DMV will also give you a          New technology
    donor sticker to place on your driver’s license or ID card.     L.A. Care follow changes and advances in health care.
    To nd out more, call 1-800-777-0133 (voice) or 1-800-         We study new treatments, medicines, procedures and
    368-4327 (TTY).                                               devices. We call all of this “new technology.” We review
                                                                  scienti c reports and information from the government
                                                                  and medical specialists.       en we decide whether to
                                                                  cover the new technology. Members and providers may
                                                                  ask L.A. Care to review new technology.




50 Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
Glossary of Terms

    is glossary will help you understand words used in        California Department of Health Care Services
 this Member Handbook.                                        (CDHCS) is the state agency that is responsible for the
                                                              Medi-Cal program.
 Acute is a word used for a serious and sudden condition
 that lasts a short time and is not chronic. Examples         California Department of Managed Health Care
 include a heart attack, pneumonia or appendicitis.           (DMHC) is the state agency responsible for regulating
                                                              health care service plans.
 Advance Directive is a signed legal document that
 allows you to select a person to make your health care       Cancer Clinical Trial is a research study with cancer
 choices at a time when you can’t make them yourself. It      patients to nd out if a new cancer treatment or drug is
 expresses your decision about your end-of-life care ahead    safe and treats a member’s type of cancer.
 of time.
                                                              Case Management refers to doctors and nurses who
 Americans with Disabilities Act (ADA) is a law that          make sure that you are getting the right health care
 protects people with disabilities from not being treated     services when you need them. is includes checkups,
 fairly. e ADA law makes sure there are equal chances         plans to make you better, getting you the right doctors,
 for people with disabilities in employment and state and     and coordinating care to meet your health care needs.
 local government services, including health care.
                                                              Certified Nurse Midwife (CNM) is a registered nurse
 Arbitration is the process by which parties to a dispute     who has experience in labor and delivery, and at least
 submit their di erences to the judgment of an impartial      one year of hands-on training in midwifery. A CNM has
 (fair and unbiased) person or group appointed by mutual      completed an advanced course of study and is certi ed
 consent or statutory provision.                              by the American College of Nurse-Midwives.

 Authorize/Authorization is when a health plan                Certified Nurse Practitioner is a registered nurse
 approves treatment for covered health care services.         who has completed an advanced training program in a
 Members may have to pay for non-approved treatment.          medical specialty.
 Note: Emergency service and out-of-area urgent care
 services do not require prior authorization.                 Child Health and Disability Prevention (CHDP)
                                                              is for people under the age of 21 with a disability.
 Benefits are the health care services, supplies, drugs       CHDP is a preventive program that delivers periodic
 and equipment that are medically necessary and covered       health assessment and services. CHDP provides care
 by Medi-Cal.                                                 coordination to assist families with medical appointment
                                                              scheduling, transportation, and access to diagnostic and
 California Children’s Services Program (CCS) is              treatment services.
 the public health program that assures the delivery of
 specialized diagnostic, treatment and therapy services to    Chronic is a word used for a condition that is long-
  nancially and medically eligible children under the age     term and ongoing, and is not acute. Examples include
 of 21 who have CCS eligible conditions.                      diabetes, asthma, allergies and hypertension.


                                    Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731). 51
    Clinic is a facility that members can select as a Primary       Evidence of Coverage and Disclosure Form
    Care Provider (PCP). It can be either a Federally               (EOC) is the L.A. Care Member Handbook which
    Quali ed Health Center (FQHC), Los Angeles County               has information about bene ts, services and terms for
    clinic, community clinic, rural health clinic, Native           members.
    American Health Clinic, or other primary care facility.
                                                                    Exclusions are any medical, surgical, hospital or other
    Complain/Complaint is an oral or written expression             treatments for which the program o ers no coverage.
    of dissatisfaction, including any complaint dispute
    request for reconsideration or appeal. A complaint is also      Expedited Review is a complaint that must be
    known as a grievance.                                           resolved as quickly as possible if it involves an imminent
                                                                    or serious threat, including but not limited to, severe
    Diagnostic/Diagnosis is when a doctor identi es a               pain or the potential loss of life, limb or major bodily
    condition, illness or disease.                                  function. With an expedited review, the health plan will
                                                                    resolve the complaint as quickly as the medical condi-
    Disability is a physical or mental condition that               tion requires and no later than within 72 hours.
    substantially limits a person’s ability in at least one major
    life activity.                                                  Experimental or investigational in nature refers
                                                                    to new medical treatment that is still being tested but
    Disenroll/Disenrollment is when a member leaves a               has not been proven to treat a condition.
    health plan.
                                                                    Family planning services help people learn about
    Disputed health care service is a health care service           and plan the number and spacing of children they want
    eligible for coverage and payment under a plan that has         through the use of birth control.
    been denied, modi ed or delayed based on the plan’s
    decision that the service was not medically necessary.          Fee-For-Service Medi-Cal, also known as regular
                                                                    Medi-Cal, is the component of the Medi-Cal Program
    Durable Medical Equipment is medical equipment                  that is paid directly by the state for services.
    used in the course of treatment or home care, including
    items such as crutches, knee-braces or wheelchairs.             Federally Qualified Health Center (FQHC) is a
                                                                    community-based health organization that provides
    Eligible/Eligibility means that a person meets certain          comprehensive primary health, oral health, mental
    requirements to receive bene ts from programs such as           health, and substance abuse services.
    Medi-Cal, California Children’s Services (CCS) and
    Child Health Disability Program (CHDP).                         Food and Drug Administration (FDA) is the
                                                                    U.S. government agency that enforces the laws on the
    Enroll/Enrollment is when a member joins a health               manufacturing, testing, and use of drugs and medical
    plan.                                                           devices.

    Emergency Services are covered anywhere–24 hours                Formulary is a list of approved drugs that is generally
    a day, seven (7) days a week. Emergency care is a service       accepted in the medical community as safe and e ective.
    a member reasonably believes is necessary to stop or
    relieve serious illness or symptoms, injury or conditions       Grievance is sometimes called a complaint. A grievance
    requiring immediate diagnosis and treatment, including          is the process used when a member is not happy with his
    physical and psychiatric emergency conditions and               or her health care. Grievances are about services of care
    active labor.                                                   received or not received.


52 Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
                                                                             2010–2011 Medi-Cal Member Handbook


Health care services prevent and treat disease, and            Independent Physician Association (IPA) is a
keep people healthy. Examples include some of the              company that organizes a group of doctors, specialists
following:                                                     and other providers of health services to see members.
• Doctor services (includes one-on-one visits with a
  doctor and referrals)                                        Infertility is when a person is not able to conceive
                                                               and produce children after having unprotected sex on a
• Emergency services (includes ambulance and out-of-           regular basis for more than 12 months.
  area coverage)
• Home health services                                         Inpatient is when a person receives medical treatment
                                                               in a hospital or other health care facility with an over-
• Hospital inpatient and outpatient services                   night stay.
• Laboratory services
                                                               Involuntary/Involuntarily is when something is
• Pharmacy services
                                                               done without choice.
• Preventive health services
• Radiology services                                           Liable/Liability is the responsibility of a party or
                                                               person according to law.
Health Maintenance Organization (HMO) is
an organization that, through a coordinated system of          Life-threatening is a disease, illness or condition that
health care, provides or assures the delivery of an agreed     may put a person’s life in danger if it is not treated.
upon set of comprehensive health maintenance and treat-
ment services for an enrolled group of persons through a       Local Education Agency is the school district or
predetermined, periodic xed prepayment.                        county o ce of education that will receive and disburse
                                                               grant funds.
Health Plan means an individual or group plan that
arranges for the provision, or pays the cost of, medical       Managed care is a health care system in which the
care.                                                          health care provider, in return for a xed fee per year from
                                                               a health plan, manages the care of the individual, includ-
Hospice is the care and services provided to people who        ing decisions about whether a specialist is required.
have received a diagnosis for a terminal illness. ese
services are given in a home or facility to relieve pain       Medi-Cal is a California health coverage program for
and provide support.                                           low-income families.   is program is funded by state
                                                               and federal dollars.
Hospital provides inpatient and outpatient care from
doctors or nurses.                                             Medi-Cal card, also known as the Bene ciary Identi -
                                                               cation Card (BIC), is the plastic card issued by the state
Human Immunodeficiency Virus (HIV) is the virus                to Medi-Cal recipients. e BIC is used by providers to
that a ects the immune system and causes the disease           verify Medi-Cal eligibility.
known as AIDS (acquired immunode ciency disorder).
                                                               Mediation is a process by which a neutral person tries
Independent Medical Review for Experimen-                      to help individuals resolve a dispute. e results of the
tal and Investigational Therapies (IMR-EIT )                   mediation are not binding.
is a process by which expert independent medical
professionals are selected to review a denial by the health    Medical group is a group of PCPs, specialists, and
plan for a medical service, drug or equipment because it       other health care providers who work together.
is experimental or investigational in nature.

                                     Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731). 53
    Medically necessary/Medical necessity refers to               Notice of Privacy Practice (NOPP) informs the
    all covered services that are reasonable and necessary        member how medical information may be used and
    to protect life, prevent signi cant illness or signi cant     distributed by the health plans.
    disability, or to ease severe pain through the diagnosis
    or treatment of disease, illness or injury.                   Occupational therapy is used to improve and main-
                                                                  tain a patient’s daily living skills when the patient has a
    Member is a person who has joined a health plan.              disability or injury.

    Member Handbook, also called a Combined                       Orthotic is used to support, align, correct or improve
    Evidence of Coverage/Disclosure Form, is what you are         the function of movable body parts.
    reading right now. It has information about the bene ts,
    services and terms o ered by the health plan.                 Outpatient is when a person receives medical treat-
                                                                  ment in a hospital or other health care facility without
    Member Representative is a person or persons                  an overnight stay.
    appointed by the member, via written statement, to
    represent them in the State of California as a health care    Out-of-area services are emergency care or urgent
    proxy, trustee named in a durable power of attorney           care services provided outside of the health plan’s service
    or court appointed guardian. Also known as Personal           area that could not be delayed until the member returned
    Representative(s), a Member Representative may be             to the service area.
    a spouse, relative, friend, advocate, your doctor, a
    practitioner or someone designated as a representative        Out-of-network providers are doctors and providers
    by the member under Durable Power of Attorney, or as          not under contract, either directly or indirectly, with the
    an Executor/Administrator of Estate or as a legal/court       health plan.
    appointed guardian.
                                                                  Pharmacy is a place to get prescribed drugs.
    Member Services Department is the health plan’s
    department that helps members with questions and              Phenylketonuria (PKU) is a rare disease. PKU
    concerns.                                                     can cause mental retardation and other neurological
                                                                  problems if treatment is not started within the rst few
    Mental or behavioral health services are given                weeks of life.
    for the diagnosis or treatment of a mental or emotional
    illness.                                                      Physical therapy uses exercise to improve and
                                                                  maintain a patient’s ability to function after an illness
    Network is a team of health care providers contracted         or injury.
    with a health plan to provide services. e health care
    providers may be contracted directly with the health          Physician is a licensed medical doctor.
    plan or through a medical group.
                                                                  Prescription is a written order given by a licensed
    Non-contracted provider is a doctor or provider               provider for drugs and equipment.
    who is not under contract with the health plan to provide
    services to members.                                          Preventive health care consists of health checkups
                                                                  or services given at certain times due to a person’s age,
    Non-formulary drug is a drug that is not listed on the        sex and medical history in order to keep that person
    health plan’s formulary and requires an authorization         well.
    from the health plan in order to be covered.


54 Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
                                                                             2010–2011 Medi-Cal Member Handbook


Primary care is a basic level of health care usually           Referrals are when a doctor sends a member to another
provided in ambulatory settings by general practitioners,      doctor, such as a specialist or providers of services
family     practitioners,     internists,    obstetricians,    including lab, X-ray, physical therapy and others.
pediatricians and mid-level practitioners. is type of
care emphasizes caring for the member’s general health         Service area means the zip codes in Los Angeles
needs as opposed to specialists focusing on speci c needs.     County that the health plan, to which a member is
                                                               assigned, serves.
Primary care provider (PCP doctor) is a doctor or
clinic that takes care of a member’s health care needs and     Skilled nursing facility (SNF) is a facility licensed to
works with the member to keep them healthy. e PCP              provide medical services for non-acute conditions.
doctor will also make specialty referrals when medically
necessary.                                                     Specialist is a physician or other health professional
                                                               who has advanced education and training in a clinical
Prior authorization is a formal process requiring              area of practice and is accredited, certi ed, or recognized
a health care provider to obtain advanced approval             by a board of physicians or peer group, or an organization
to provide speci c services or procedures. Prior               o ering qualifying examinations (board certi ed) as
authorization is required for most services or care.           having special expertise in that clinical area of practice.
However, for emergency or out-of-area urgent care
services, prior authorization is not required.                 Specialty mental health services are rehabilitative
                                                               services that include mental health services, medication
Prosthesis is used to replace a missing part of the body.      support services, day treatment intensives, day
                                                               rehabilitation, crisis intervention, crisis stabilization,
Providers are contracted with a health plan to provide         adult residential treatment services, crisis residential
covered health care services. Examples include:                services, and psychiatric health facility services such as:
• Doctors                                                      • Psychiatric inpatient hospital services
• Clinics                                                      • Targeted case management
• Hospitals                                                    • Psychiatric services
• Skilled nursing facilities                                   • Psychologist services
• Home health agencies                                         • Early, Periodic, Screening, Diagnosis and Treat-
                                                                 ment (EPSDT) supplemental specialty mental health
• Pharmacies
                                                                 services
• Laboratories
• X-ray facilities                                             Speech therapy is used to treat speech problems.
• Durable medical equipment suppliers                          Standing referral is a referral by a doctor for more
                                                               than one visit by a specialist.
Provider directory is a list of providers contracted
with a health plan.                                            TTY/TDD is a telecommunications device for the deaf.
Provider network is a group of doctors, specialists,           Urgent care is any service required to prevent serious
pharmacies, hospitals and other health care providers          deterioration of health following the onset of an
that are contracted by and work with the health plan.          unforeseen condition or injury.



                                     Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731). 55
    Women, Infant and Children Program (WIC) is a
    state nutrition program that helps pregnant women, new
    mothers and young children eat well and stay healthy.




56 Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731).
Important phone numbers
  L.A. Care Health Plan                                                                                                  1-888-839-9909
  L.A. Care’s 24-Hour Nurse Advice Line                                                                                  1-800-249-3619
  L.A. Care Compliance Helpline                                                                                          1-800-400-4889
  Disability Services
      California Relay Service (CRS) — TTY/TDD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .711
       . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sprint 1-888-877-5379 (Voice)
       . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .MCI 1-800-735-2922 (Voice)
      Americans with Disabilities Act (ADA) Information . 1-800-514-0301 (Voice) – 1-800-514-0383 (TDD)

  Children’s Services
      California Children’s Services (CCS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-800-288-4584
      Child Health and Disability Prevention (CHDP) . . . . . . . . . . . . . .1-800-993-2437 (1-800-993-CHDP)

  California State Services
      California State Department of Health Services (CDHS) . . . . . . . . . . . . . . . . . . . . . . . . 1-916-445-4171
      CDHS Ombudsman O ce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-888-452-8609
      Denti-Cal Bene ciary Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-800-322-6384
      Department of Social Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-800-952-5253
      Department of Managed Health Care (DMHC) . . . . . . . . . . . 1-888-466-2219 (1-888-HMO-2219)
      Health Care Options:
        Armenian . . . . . . . . . . . . . . . . 1-800-840-5032              Lao . . . . . . . . . . . . . . . . . . . . . 1-800-430-4091
        Cambodian/Khmer . . . . . . . . 1-800-430-5005                       Russian . . . . . . . . . . . . . . . . . 1-800-430-7007
        Cantonese . . . . . . . . . . . . . . . 1-800-430-6006               Spanish . . . . . . . . . . . . . . . . . 1-800-430-3003
        English . . . . . . . . . . . . . . . . . . 1-800-430-4263           Tagalog . . . . . . . . . . . . . . . . . 1-800-576-6890
        Farsi . . . . . . . . . . . . . . . . . . . . 1-800-840-5034         Vietnamese. . . . . . . . . . . . . . . 1-800-430-8008
        Hmong . . . . . . . . . . . . . . . . . 1-800-430-2022
      U.S. O ce for Civil Rights . . . . . . . . . . . . . . . . . . . . . . . . . . 1-866-627-7748 – 1-866-788-4989 (TTY)

  Social Security Administration
      Supplemental Social Income (SSI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-800-772-1213

  Los Angeles County Services
      Department of Public Social Services (DPSS)
      Central Help Line (includes language services) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-877-481-1044
      Customer Service Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-866-613-3777

  DPSS Public Charge Information Lines:
      Los Angeles County Department of Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-213-250-8055
      Los Angeles County Department of Mental Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-800-854-7771
      Women, Infant and Children (WIC) Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-888-942-9675



                                         Questions? Call L.A. Care Member Services at 1-888-839-9909 (TTY 1-866-522-2731). 57
                            www.lacare.org



Preventive Health Guidelines
for Adults




                 How to Stay Healthy




                                             59
     How to Stay Healthy
     Going to your doctor for regular checkups helps you                               If you are a new member, see your doctor right away
     stay healthy. This guide tells you when to go and what                            for your first checkup. Remember to go for a checkup
     needs to be done at these checkups.                                               every year. Regular checkups help you stay healthy!

     Your doctor is always a good resource for you and your
     family. You can ask questions and get advice about
     important health topics.



        Well Care Guidelines for Adults*
                     Tests/Exams                            19 to 39 Years                         40 to 64 Years                           65+ Years
         Checkup: medical history, physical
      exam, height, weight, and BMI (a test for           Every 1 to 3 years                        Every 2 years                           Every year
                weight problems)
                   Blood Pressure                                                                Every 1 to 2 years
                                                                                                   Age 50 to 75:
                                                  Your doctor will talk to you about having one or more of these tests:
              Colon and Rectal Cancer             • Fecal Occult blood test: every year [a test to see if there is blood in your stool (bowel movement)]
                                                  • Flexible sigmoidoscopy: every 5 years (a test of the lower part of your colon for cancer)
                                                  • Colonoscopy: every 10 years (a test of a larger part of your colon)
                 Hearing and Vision                                                               As recommended
                                                                             Recommended for all adults as part of their initial checkup.
      Tuberculosis (TB) Test and Risk Screening
                                                                                Doctors will also screen those at a higher risk for TB.




     Immunizations/Shots for Adults*
               Immunizations (Shots)                        19 to 39 Years                          40 to 64 Years                          65+ Years
          Tetanus-Diphtheria (Td) Tetanus
                                                                                                   Every 10 years
       (Lockjaw-tightening of the jaw muscle)
                   Pneumococcal
                                                                  —                                      —                                   One dose
      (Bacteria-can cause lung or blood infection)
                 In uenza (Flu shot)                                                                 Every year
           Human Papilloma Virus (HPV)             For women up to age 26 (3 doses),
                                                                                                         —                                      —
           (Virus-can cause cervical cancer)            if not immunized before
              Shingles (Herpes Zoster)
          (Virus-can cause painful skin rash                                       —                                               One dose, starting at age 60
                     with blisters)

     * Your doctor may recommend other screenings or immunizations (shots) such as Hepatitis, if you are at high risk.

                                                                                         Questions?
                                                                                         Call 1-888-839-9909
60                                                                                                                                                         LA0220 08/10
How to Stay Healthy
Well Care Guidelines for Men
             Tests/Exams                         20 to 39 Years                       40 to 64 Years                            65+ Years
                                                                                                             As recommended
  Screening for Prostate Cancer                       —
                                                                                                      Not recommended after age 75
       Cholesterol Screening            Ages 20 - 35 only if at high risk                             35 and older as recommended


Well Care Guidelines for Women
              Tests/Exams                      19 to 39 Years                        40 to 64 Years                             65+ Years
            Mammogram
                                                     —                      First mammogram by age 50, then every 1 to 2 years after 50
       (an X-ray of the breasts)
      Pelvic Exam (Pap Smear)         Pelvic exam and cervical cancer screening (Pap Smear) by age 21, then every 1 to 3 years as doctor recommends
        Chlamydia Screening
                                                         To be done regularly for women 16 to 25 years (up to their 26th birthday) and
          [a test for a sexually
                                                                         only for women who are at high risk over 25
       transmitted disease (STD)]
             Osteoporosis
                                                                        Screening for 65+ or younger as recommended
        (thinning of the bone)
                                                                                 Ages 20 to 45 only if at high risk
       Cholesterol Screening
                                                                                  After age 45 as recommended


How to Stay Healthy When You Are Pregnant
Care Before Pregnancy:
Before you are pregnant, your doctor will talk to you about a vitamin (folic acid) that helps prevent birth
defects. As soon as you think or you know you are pregnant, SEE YOUR DOCTOR RIGHT AWAY!

Care During Pregnancy (Prenatal):
                                  Checkups:                                                                     How Often?
                                First 28 Weeks                                                                 Every 4 weeks
                                 29-36 Weeks                                                                  Every 2-3 weeks
                             36 weeks and beyond                                                                  Weekly


Each checkup is important to help keep you and your baby healthy
  •      Certain tests may be done during your checkups
  •      Your doctor may want to see you more often

Care After Pregnancy (Postpartum):
  •      After you have your baby, it is important you get a checkup (postpartum check)
  •      Postpartum checkup should be done 21 to 56 days after you have your baby
  •      If you have a surgical delivery (C-section), you will need 2 checkups


                                                                                                                                                      61
         How to Stay Healthy

           You may also talk to your doctor about:
                 Aspirin
                 Asthma
                 Dental Health
                 Diabetes
                 Drug and Alcohol Problems
                 Exercise
                 Family Planning/Birth Control
                 How to Quit Smoking
                 Nutrition
                 Parenting
                 Safety Tips
                 STDs and HIV
                 Violence and Abuse
                 Weight Problems



      You may also call the
      Nurse Advice Line 24/7
      at 1-800-249-3619
      for health questions.




 Sources for all information in this document: 2009 update from U.S.
 Preventive Services Task Force, Centers for Disease Control and Prevention
 (CDC) and The American College of Obstetricians and Gynecologists
 Guideline for Perinatal Care (2007 edition).

62
                             www.lacare.org




Preventive Health Guidelines




               How to Keep Your Child
                      or Teen Healthy




                                              63
     How to Keep Your Child or Teen Healthy
     Take your children and teens to the doctor for regular                  If your child or teen is a new member, take them
     checkups to help them stay healthy. This guide tells you                to the doctor right away for their first checkup.
     when to take them and what needs to be done at these                    Remember, regular checkups help them stay healthy!
     checkups.
     Your doctor is always a good resource for you and your
     family. You can ask questions and get advice about
     important health topics.



            Well Care Guidelines for Infants and Young Children*
                         What will be done                       When to go to the doctor                   When to go to the doctor
                            Tests/Exams                             Birth to 2 years                            3 to 10 years
                           Well Care Visit:
                 History, physical exam, screenings         A few days after hospital discharge,
                for growth, development, and risky            by 1 month, at 2, 4, 6, 9, 12, 15,                    Every year
               behaviors, health education, advice on              18, 24 and 30 months.
                 what to expect at your child’s age
                                                                     At 7 to 9 months,
                     Blood Test (for anemia)                                                                  At each well child visit
                                                              13 to 15 months and at 2 years
                           Urine Test                                                                 At age 4 to 5 and every couple of years
                         Blood Pressure                                                                    Every year starting at age 3
                      Tuberculosis (TB) Test                                                                TB Test between age 4 to 5
                                                           Ask your doctor if your child is at risk
                       and Risk Screening                                                                    required for kindergarten
                         Lead Screening                         At 12 months and at 2 years                          As needed
                                                                   Screening at each visit
                 Oral Health (teeth and gums)**                                                               Screening at each visit
                                                         Get a referral to dentist by age 12 months


            *Your doctor may order these tests more or less often as needed.
            ** California law now requires children to have a dental checkup
            by a dentist or dental hygienist by May 31 of their rst school
            year (public school kindergarten or rst grade level).




                                                 Questions?
                                                 Call 1-888-839-9909


64                                                                                                                                       LA0221 08/10
How to Keep Your Child or Teen Healthy

Well Care Guidelines for Older Children and Teens*
                             What will be done                                                  When to go to the doctor
                                Tests/Exams                                                        11 to 19 years
                               Well Care Visit:
   History, physical exam, screenings for growth, development, and risky                                Every year
  behaviors, health education, advice on what to expect at your child’s age
                                                                                               At least once every 2 to 3 years
                         Blood Test (for anemia)
                                                                                  Every year for females who have started their periods
                               Urine Test                                       Every couple of years or more often if doctor recommends
                          Cholesterol Screening                                                  When doctor recommends
                                                                                Pelvic exam and cervical cancer screening (Pap Smear) by
                         Pelvic Exam (Pap Smear)
                                                                                 age 21 for all females; more often if doctor recommends
             Sexually Transmitted Disease (STD) Screening
                                                                                        Every year for all sexually active patients
                      (including Chlamydia, HPV)
                                                                                       Ask your doctor if your child is at high risk
                Tuberculosis (TB) Test and Risk Screening
                                                                                            TB Test between age 11 and 16

*Your doctor may order these tests more or less often as needed.




          You can also ask to talk with your doctor about these topics:
            Asthma                                                   Parenting
            Dental Health                                            Prenatal Health
            Diabetes                                                 (for pregnant women)
            Drug and Alcohol Problems                                Safety Tips
            Exercise                                                 STDs and HIV
            Family Planning/Birth Control                            Tobacco
            Healthy Foods                                            Violence and Abuse
            High Blood Pressure                                      Weight Problems




Sources for all information in this document: American Academy of Pediatrics
(AAP); California Department of Health Services, Children’s Medical Services
Branch, Child Health and Disability Prevention Program (CHDP); 2009
Advisory Committee on Immunization Practices, Department of Health
and Human Services, Centers for Disease Control and Prevention.

                                                                                                                                           65
     How to Keep Your Child or Teen Healthy
     Get Your Child the Right Shots at the Right Time
     Your child will need shots at different times to stay healthy. ese shots protect your child from serious diseases.
     Use the guide below to find out about the shots needed. Your doctor can help you understand what each shot does.



                                                                                                               Diseases Prevented by
            Age                         Your child should get these shots
                                                                                                                 the Vaccine (shot)
           Birth         Hepatitis B ** (Some infants may get their rst shot at birth)     Hepatitis B - a bad disease that hurts the liver
         2 Months        Hepatitis B ***                                Polio (#1)
                                                                                           Diphtheria – causes a thick covering in the back of the throat
                         DTaP (#1) Diphtheria, Tetanus, and Pertussis
                         Hib (#1) Haemophilus in uenzae type b                             Tetanus – (Lockjaw) causes tightening of the jaw muscle
                         PCV (#1) Pneumococcal disease                  Rotavirus (#1)
                                                                                           Pertussis - (Whooping Cough) causes bad coughing spells
         4 Months        Hepatitis B ***        Rotavirus (#2)
                         DTaP (#2)              Hib (#2)                                   Hib Meningitis – an infection of the brain
                         PCV (#2)               Polio (#2)                                 and spinal cord
         6 Months        Hepatitis B ***        Rotavirus (#3)
                                                                                           PCV Pneumococcal disease – causes blood infection,
                         DTaP (#3)              Hib (#3)
                                                                                           pneumonia, and infection of the brain
                         PCV (#3)               Polio (#3)
        12 Months*       Hib (#4)                                       PCV (#4)           Polio – can cause paralysis (can’t move arms or legs)
                         MMR (#1) Measles, Mumps, and Rubella           Hepatitis A (#1)
                                                                                           Rotavirus – causes bad diarrhea
                         Varicella-Chickenpox (#1)
        15 Months*       DTaP (#4) (can be given as early as 12 months)                    Measles – causes rash, cough, runny nose, eye irritation, and
                    *    Hepatitis A (#2)                                                  fever
        18 Months
         Age 4 to 6      DTaP (#5)                            Polio (#4)                   Mumps – causes fever, headache, and swollen glands
          (Before        MMR (#2)                             Varicella-Chickenpox (#2)
       Kindergarten)     Get these shots if they were missed before:                       Rubella – (German Measles) causes rash, mild fever
                         Hep B Series – Hep A Series – Hib                                 Varicella-(Chickenpox) rash, skin blisters, itching, and fever
        Age 11 to 12     MCV4 Meningococcal (Meningitis)
      (Before 7th Grade) Tdap (Tetanus, Diphtheria, Pertussis)                             Hepatitis A – causes a bad liver disease
                         HPV (3 doses) Human Papilloma Virus
                                                                                           MCV4 Meningococcal (Meningitis) – an infection of the
                         Get these shots if they were missed before:
                         Hep B series – Hep A series – Polio series                        brain and spinal cord
                         MMR (#2) – Pneumococcal series – Varicella                        HPV (Human Papilloma Virus) – can cause cervical cancer
        Age 13 to 18     If shots not received at ages 11 to 12:                           and genital warts
                         MCV4 (at age 15)
                         HPV (3 doses)
                         Tdap

     * Check with your doctor to see if your child needs any “catch-up” shots.
     ** Your child may get a total of 4 Hepatitis B shots if your doctor uses both single antigen
        and combination vaccines.
     *** Hepatitis B Vaccine is usually given at 2, 4, and 6–18 months (3 doses).




66
        Notice of Privacy Practices
        A Message for Medi-Cal Members
        Please review it carefully.                                                                                   www.lacare.org



        This notice describes how medical information about you           Employees must ensure member PHI is picked up from fax
        may be used and disclosed and how you can get access to           machines, printers and copiers and only is received by those who
                                                                          have access. Portable media devices with PHI are encrypted and
        this information.
                                                                          must have password protections applied. Computer screens and
                                                                          work stations must have privacy screen lters and workstations,
          L.A. Care Health Plan provides health care to you for the
                                                                          drawers and cabinets have secure locks placed on them.
        Medi-Cal program. We are required by state and federal law
        to protect your health information. We also must give you this
        Notice. is Notice tells you how we may use and share your
                                                                          Your Information is Personal and Private
        information. It also tells you what your rights are.                We get information about you from Medi-Cal after you join
                                                                          our health plan. We also get medical information from your
        What is “Protected Health Information?”                           doctors, clinics, labs and hospital so we can approve and pay
                                                                          for your health care.
           Your Protected Health Information (“PHI”) is health
        information that contains identi ers, such as your name,
                                                                          Changes to Notice of Privacy Practices
        Social Security number, or other information that reveals who
        you are. For example, your medical record is PHI because it         L.A. Care must obey the Notice that we are using now. We
        includes your name and other identi ers.                          have the right to change these privacy practices. Any changes
           Your con dentiality is important to us. We are required by     in our practices will apply to all of your medical information.
        state and federal law to protect your health information. Our     E ective April 14, 2003, whenever there is an important change
        sta follows policies and procedures at L.A. Care Health Plan      in our practices, we will change this Notice and notify you.
        which protects your health information given to us in oral,
        written or electronic ways.                                       How We May Use and Share Information About You
           Our sta goes through training which covers the internal          L.A. Care may use or share your information only for a
        ways members’ oral, written and electronic PHI may be used        reason directly connected to the Medi-Cal program. Some of
        or disclosed across the organization. All L.A. Care sta with      the information we use and share is:
        access to your health information is trained on privacy and         • Your name,
        information security laws. Sta has access only to the amount        • Address,
        of information they need to do their job.                           • Personal facts,
           Our computer systems protect your electronic PHI at              • Medical care given to you,
        all times by using various levels of password protection and        •    e cost of your medical care, and
        software technology.
                                                                            • Your medical history.
           Our L.A. Care employees follow internal practices, policies
        and procedures to protect any conversations about your health       Some actions we take when we act as a Medi-Cal health plan
        information. For example, employees are not allowed to speak      include:
        about your information in elevators or hallways. Employees must     • Checking whether you are covered by Medi-Cal,
        also protect any written or electronic documents containing         • Checking the amount of medical aid you can get from
        your health information across the organization.                       Medi-Cal,
           Fax machines, printers, copiers, computer screens, work          • Approving, giving, and paying for Medi-Cal services,
        stations, portable media disks containing your information          • Investigating or taking legal action in Medi-Cal cases (like
        are carefully guarded from others who should not have access.          fraud),

LA0260 08/10                                                                                                                           67
     Notice of Privacy Practices, cont’d

       • Checking the quality of care you receive,                       What Are Your Privacy Rights?
       • Making sure you get all the care you need.                         You have the right to ask us not to use or share your personal
                                                                         health care information. We will send you a form to ll out to
          ese are some examples of how we may use and share              tell us what you want. Or, we can ll out the form for you. We
     information about you:                                              may not be able to agree to your request.
       • For treatment: You may need medical treatment that needs           You have the right to ask us to contact you only in writing
         to be approved ahead of time. We will share information         or at a di erent address, post o ce box, or by telephone. We
         with doctors, hospitals and others in order to get you the      will send you a form to ll out to tell us what you want. Or, we
         care you need.                                                  can ll out the form for you. We will accept reasonable requests
       • For payment: We share your information with other               when necessary to protect your safety.
         health plans or providers that are responsible to pay for          You and your personal representative have the right to get a
         your care. We may also forward bills to other health plans      copy of your health information. We will send you a form to
         or providers for payment.                                         ll out to tell us what you want copied. Or, we can ll out the
       • For health care operations: We may use information              form for you. You may have to pay for the costs of copying and
         in your health record to check the quality of the health        mailing records. (We may keep you from seeing certain parts of
         care you receive. We may also use this information in           your records for reasons allowed by law.)
         audits, programs to stop fraud, planning, and general              You have the right to ask that information in your records
         administration.                                                 be changed if it is not correct or complete. We will send you a
                                                                         form to ll out to tell us what changes you want. Or, we can ll
     Other Uses for Your Health Information                              out the form for you. We may refuse your request if
       Sometimes a court will order us to give out your health infor-       •     e information is not created or kept by L.A. Care, or
     mation. We will also give information to a court, investigator,        •     e information is not part of a standard set of information
     or lawyer if it is about the operation of Medi-Cal. is may in-            kept by us, or
     volve fraud or actions to get money from others when Medi-Cal          •     e information has been gathered for a court case or other
     has paid your medical claims.                                             legal action, or
       You or your doctor, hospital, and other health care providers        • We believe it is correct and complete.
     may not agree if we decide not to pay for your Medi-Cal care.
     We may use your health information to review these decisions.          We will let you know if we agree to make the changes you
                                                                         want. If we don’t agree to make the changes you want, we
       We may share your health information with groups that
                                                                         will send you a letter telling you why. You may ask that we
     check how our health plan is providing services.
                                                                         review our decision if you disagree with it. You may also send
       We may share your information with persons involved in            a statement saying why you disagree with our records. We will
     your health care, or with your personal representative.             keep your statement with your records.
       We must share your health information with the federal
     government when it is checking on how we are meeting pri-
     vacy rules.                                                         Important
       We may also share your information when the law says we           L.A. Care does not have complete copies of your medical
     can or must share it, such as for national security purposes. But   records. If you want to look at, get a copy of, or change your
     we will not share your information if the Medi-Cal program          medical records, please contact your doctor or clinic.
     would not allow it.
       L.A. Care sta is trained to protect information given to
     plan sponsors or employers. L.A. Care requires plan sponsors          E ective April 14, 2003, whenever we share your health
     or employers to have the same protections as L.A. Care has in       information, you have the right to request a list of:
     place. Plan sponsors or employers must agree to protect your          • Whom we shared the information with,
     medical information.                                                  • When we shared it,
                                                                           • For what reasons, and
     When Written Permission is Needed                                     • What information was shared.
       If we want to use your information for any purpose not listed
                                                                              is list will not include when we share information with
     above, we must get your written permission. If you give us your
                                                                         you, with your permission, or for treatment, payment, or health
     permission, you may take it back in writing at any time.
                                                                         plan operations.
68
Notice of Privacy Practices, cont’d

  You have a right to request a printed paper copy of this Notice   Use Your Rights Without Fear
of Privacy Practices. You may get a paper or printed copy of this     L.A. Care cannot take away your health care bene ts or do
communication by calling the Privacy O cer. You can also            anything to hurt you in any way if you le a complaint or use
 nd this Notice on our website at www.lacare.org.                   any of the privacy rights in this Notice.

How Do You Contact Us to Use Your Privacy Rights?                   Questions
 If you want to use any of the privacy rights explained in this        If you have any questions about this Notice and want further
Notice, please call or write us at:                                 information, please contact the L.A. Care Privacy O cer,
  L.A. Care Privacy O cer                                           L.A. Care Health Plan, at the address and phone number in
  L.A. Care Health Plan                                             the “How Do You Contact Us to Use Your Rights?” section.
  555 West Fifth Street                                                To get a copy of this notice in other languages, Braille,
  Los Angeles, CA 90013                                             large print, on audiocassette or CD-ROM, please call or
  Toll-free: 1-888-839-9909                                         write the L.A. Care Privacy O cer at the number or address
  California Relay: 1-800-854-7784 or                               listed above.
  1-866-LA-CARE1 (1-866-522-2731) TTY

Complaints
  If you believe that we have not protected your privacy,
you have the right to complain. You may le a complaint (or
grievance) by contacting us at:
  L.A. Care Privacy O cer
  L.A. Care Health Plan
  555 West Fifth Street
  Los Angeles, CA 90013
  Toll-free: 1-888-839-9909

  OR you may contact the agencies below:

  • Privacy O cer
    c/o O ce of Legal Services
    CA Department of Health Care Services
    1501 Capitol Avenue
    P.O. Box 997413, MS0010
    Sacramento, CA 95899-7413
    1-916-445-4646 or 1-877-735-2929 TTY/TDD
    Fax: 1-916-440-7680
    E-mail address: privacyo cer@dhcs.ca.gov
  • Secretary of the U.S. Department of Health and
    Human Services
    O ce for Civil Rights
    Attention: Regional Manager
    50 United Nations Plaza, Room 322
    San Francisco, CA 94102
    For additional information, call 1-800-368-1019
  • U.S. O ce for Civil Rights at 1-866-OCR-PRIV
    (1-866-627-7748) or 1-866-788-4989 TTY



                                                                                                                                69
  Nurse Advice Line
  List of Audio Health Topics
  1-800-249-3619                                                                                                    www.lacare.org



   Allergies and Immune System                   Agoraphobia                        3303    Gender Identity Disorder            3329
   Allergies                              3100   Alcohol and Aging                  3004    Grief and Loss                      3330
   Allergy Tests                          3103   Alcohol and Health                 4400    Hallucinations                      3331
   Controlling Your Environment                  Alcohol Dependence                 3304    Healthy Love Relationships and Teens 3773
     When You HaveAllergies               3102   Amnesia                            3306    Hypnotherapy                        3333
   Drug Allergy                           3107   Anger and Teaching Children                Hypochondria or
   Enlarged Lymph Nodes in Children       3811    to Manage It                      3788     Hypochondriasis Disorder           3334
   Flu Shots for Seasonal Flu             4441   Anger Management                   3307    Incest                              3335
   Food Allergy                           3109   Anger Management for Parents       4301    Kleptomania                         3336
   Food Allergy in Children               3814   Anorexia                           3308    Letting Go of Resentment            3337
   Guillain-Barré Syndrome                3412   Antisocial Personality Disorder    3309    Living with a Mentally Ill Person   3374
   Hay Fever                              3110   Anxiety                            3310    Living with an Alcoholic Parent     3700
   Hay Fever in Children                  3817   Autism                             3704    Loneliness in Older Adults          3022
   Hives                                  3111   Autistic Spectrum Disorders        3377    Marijuana                           3375
   Immunization Schedule for Children     4663   Binge Eating Disorder or                   Masochism                           3339
   Immunizations for Adults               4664     Compulsive Overeating            3313
                                                                                            Masturbation                        3733
   Lupus                                  3207   Bipolar Disorder                   3314
                                                                                            Multiple Personality or
   Lymph Nodes, Enlarged                  5063   Bulimia                            3315     Dissociative Identity Disorder     3341
   Myasthenia Gravis                      3419   Bullying and How to Help the Victim 3370   Narcissism or Narcissistic
   National Support Services for                 Child Abuse and Neglect            3300     Personality Disorder               3342
     People Who Have Allergies            3101   Choosing a Mental Health                   New Baby Creates Jealousy           3739
   Poison Ivy, Sumac, and Oak             3112       erapist for Your Child         3371    OCD or Obsessive-Compulsive
   Scleroderma                            3231   Cocaine Use                        3317     Disorder                           3345
   Severe Allergic Reaction               3113   Cognitive-Behavioral      erapy    3373    Panic Attacks or Panic Disorder     3346
   Shots for Travel                       4443   Compulsive Gambling                3318    Paranoid Personality Disorder       3347
   Sjogren’s Syndrome                     4867   Depression in Children and Teens   3772    Pedophilia                          3348
   Tetanus Shot                           4942   Depression in Older Adults         3010    Phobias                             3349
                                                 Depression Overview                3321    Positive Attitude                   3703
   Behavioral Health                             Designer Drugs                     3316    Postpartum Depression               5269
   Abuse and Domestic Violence                   Disciplining Your Child            4313    Post-Traumatic Stress Disorder      3350
     in Adults                            3301
                                                 Dyslexia                           3720    Prescription Drug Abuse             3351
   Abuse of Older Adults                  3001
                                                 Emotional Abuse: E ects on Children 3326   Psychosis                           3352
   ADHD or Attention De cit
     Hyperactivity Disorder in Adults     3311   Exhibitionism                      3327    Psychosomatic Illness               3353
   ADHD or Attention De cit                      Fetal Alcohol Syndrome             3724    Pyromania                           3354
     Hyperactivity Disorder in Children   3312   Fetishism                          3328    Recognizing Drug Abuse in Kids      3323
   Aggressive Behavior in Children        3302   Food and Feelings                  4703    Ritalin                             4280


LA0281 08/10                                                                                                                       71
SAD or Seasonal A ective Disorder      3357    Bones, Muscles and Joints                          Trigger Finger                        3251
Sadism                                 3355    Amputation                               3151
Schizophrenia                          3356    Arthritis                                3154      Brain and Nervous System
Self-Esteem                            3358    Arthroscopy                              3157      AIDS - Nervous System Complications 3400
                                               Aspirin and Arthritis                    3159      Alzheimer’s Disease                   3401
Self-Esteem for Teens                  3763
                                               Back Pain Prevention at Work             4650
Self-Esteem in Older Adults            3032                                                       Bell’s Palsy                          3403
                                               Baker’s Cyst                             3269
Separation Anxiety Prevention          4329    Bone Chips in the Elbow                  3267      Brain Tumors in Children              3505
Sexual Abuse and Children              3360    Bone Chips in the Knee                   3268      Cerebral Palsy                        4305
Sexual Behaviors in Children           3801    Bowlegs and Knock-Knees                  3163      Chronic Fatigue Syndrome              4406
Social Anxiety Disorder                3379    Brittle Bones in Children                3218      Cluster Headaches                     3405
Stress                                 4425    Bursitis                                 3169
                                                                                                  Confusion                             3407
                                               Calci c Tendonitis                       3170
Stress Management                      4426                                                       Delirium                              3408
                                               Carpal Tunnel Syndrome                   3171
Stress Management with                                                                            Dementia                              3409
                                               Cast Care                                3172
  Deep Breathing                       4427
                                               Chores Made Easier                                 Dizziness and Vertigo                 5054
Stress Management with                            When You Have Arthritis               3155
                                                                                                  Epilepsy                              3410
  Mental Imaging                       4428    Coping with Arthritis                    3259
                                                                                                  Facial Tics                           3411
Stress Management with                         Costochondritis                          3173
  Progressive Muscle Relaxation        4429    Curved Spine or Scoliosis                3232      Fatigue                               5056
Suicide                                3363    Dupuytren’s Contracture                  3256      Fibromyalgia                          3177
Talking with Your Child                        Frozen Shoulder or Adhesive Capsulitis   3187      Fluid on the Brain or Hydrocephalus   3415
  about Drinking and Drugs             4338    Ganglion Cyst                            3188
                                                                                                  Huntington’s Disease                  3414
Teenage Drinking                       3364    Gout                                     3189
                                                                                                  Lou Gehrig’s Disease                  3416
                                               Hip Dislocation in Childhood             3192
     e Stresses of Chronic Illness     4433
                                               Juvenile Rheumatoid Arthritis            3198      Lumbar Stenosis                       3206
Transvestism                           3365
                                               Knee Arthroscopy                         3199      Migraine Headache                     3418
Treating Teens for Substance Abuse     3322    Low Back Pain                            3205      Migraine Headaches in Children        3436
Twelve Step Programs                   3366    Muscle Cramps and Spasms                 3209      Multiple Sclerosis                    3435
Types of     erapy for Mental Health   3367    Muscular Dystrophy                       3738
                                                                                                  Parkinson’s Disease                   3423
Voyeurism                              3368    Neck Spasms                              3213
                                               Osgood-Schlatter Disease                 3216      Peripheral Neuropathy                 3424
When Your Child Is a Bully             3369
                                               Osteoarthritis                           3217      Restless Legs Syndrome                4421
Your Child’s Self-Esteem               4344
                                               Osteoporosis                             3219      Sciatica                              3425
                                               Paget’s Disease of Bone                  3221      Seizures                              3426
Blood and Cancer
                                               Pigeon Toe                               3223
Anemia                                 4402                                                       Seizures in Children                  3820
                                               Polymyalgia Rheumatica                   3225
Blood Clots                            3607                                                       Spina Bi da                           4337
                                               Rheumatoid Arthritis                     3228
Blood Donation                         4403    Septic Arthritis                         3233      Stroke                                3430
Blood Transfusion                      4404    Shoulder Bursitis                        3235      Stroke Rehabilitation                 3647
Bone Marrow or Stem Cell Transplant 3503       Slipped Disk or Herniated Disk           3241      Tension Headache                      3432
                                               Spondylolysis and Spondylolisthesis      3244
Childhood Leukemia                     3500                                                       Tic Disorders                         3778
                                                  e Hip Problem of
Hemophilia                             4321       Legg-Calve-Perthes Disease            3203      Tourette’s Syndrome                   3781
Sickle Cell Anemia                     4334    Torticollis                              3250      Trigeminal Neuralgia                  3433


                You can call L.A. Care’s 24-hour nurse advice line at 1-800-249-3619.
72                                     You can call this number for free anytime, day or night.
Cancer                                      Breast-Feeding and How to                      Very Small Premature Baby       3784
                                              Increase Your Milk Supply             4740   Weaning from Bottle to Cup      3797
Biological     erapy             3525
                                            Breast-Feeding Bene ts                  3708   Weaning from Breast to Bottle   3798
Bladder Cancer                   3501
                                            Breast-Feeding Positions                3790   Weaning from Breast to Cup      3799
Bone Cancer                      3502
                                            Circumcision                            3712
Brain Cancer                     3504
                                            Croup                                   3714   Diabetes
Breast Cancer in Men             3507
                                            Crying Baby                             3715   Diabetes: A1C Test              3924
Breast Cancer in Women           3506
                                            Formula Feeding                         3725   Diabetes: Type 1                3905
Cancer and Ways to
 Protect Yourself Against It     4671       Growth Delay or Disorder                3911   Diabetes: Type 2                3906
                                            Jaundice in Newborns                    3731   Diabetes and Alcohol            4718
Cancer Clinical Trials           3515
                                            Lead Poisoning Prevention in Children   3800   Diabetes and Eating Out         4715
Cancer Prevention and Diet       4652
                                            Medical Reasons Not to Breast-Feed      5336   Diabetes and Food Management    3902
Cancer Screening                 3511
                                            Normal Development                             Diabetes and Heart Disease      3921
Cancer Treatment Team            3513
                                              12 to 15 Months Old                   3742   Diabetes and Illness            3900
Cancer Warning Signs             3517
                                            Normal Development                             Diabetes and Nerve Damage       3922
Cervical Cancer                  3518         15 to 18 Months Old                   3743
                                                                                           Diabetes and Preventing Low
Chemotherapy                     3519       Normal Development                               Blood Sugar during Exercise   3923
Childhood Cancers                3711         2 to 4 Months Old                     3745
                                                                                           Diabetes and the Importance
Chronic Lymphocytic Leukemia     3520       Normal Development                               of Exercise                   3904
                                              2 Weeks to 2 Months Old               3746
Colon and Rectal Cancer          3521                                                      Diabetes Foot Care              3901
                                            Normal Development 2 Years Old          3747
Endometrial Cancer               3547                                                      Diabetes Self Blood
                                            Normal Development 3 Years Old          3748     Glucose Monitoring            3903
Esophageal Cancer                3523
                                            Normal Development                             Diabetic Eye Problems           3907
Hodgkin Lymphoma                 3524         4 to 6 Months Old                     3749
Kidney Cancer                    3526                                                      Diabetic Ketoacidosis           3908
                                            Normal Development 4 Years Old          3750
Liver Cancer                     3527                                                      Diabetic Retinopathy            3909
                                            Normal Development 5 Years Old          3751
Lung Cancer                      3528                                                      High Blood Sugar                3912
                                            Normal Development
                                              6 to 9 Months Old                     3752   Hyperosmolar Hyperglycemic
Melanoma                         3529
                                                                                             Nonketotic State              3913
Multiple Myeloma                 3531       Normal Development
                                              9 to 12 Months Old                    3753   Low Blood Sugar                 3915
Non-Hodgkin Lymphoma             3532
                                            Overweight Children                     4721   Metabolic Syndrome              3917
Ovarian Cancer                   3533                                                      Type 1 Diabetes in Children     3782
                                            Reye’s Syndrome                         3760
Pancreatic Cancer                3535
                                            Sleep Apnea in Babies                   3789
Prostate Cancer                  3537                                                      Diagnostic Tests and Procedures
                                            Sleep Patterns in Babies                3765
Radiation      erapy             3540                                                      Angiograms                      5100
                                            Sleep Patterns in Children              3764
Skin Cancer                      3541                                                      Arterial Blood Gases            5101
                                            Speech Development in
Stomach Cancer                   3543         Newborns to 5 Year Olds               3769   Barium Enema                    5102
Testicular Cancer                3544       Spitting Up in Infants                  3770   Barium X-Ray Exam of the
  roat Cancer                    3545                                                        Esophagus and Stomach         5103
                                            Sudden Infant Death Syndrome
  yroid Cancer                   3546         or SIDS                               3771   Biopsy                          5104
                                            Temper Tantrums                         3775   Blood Glucose Test              5105
Children                                       umbsucking                           3777   Blood Pressure                  3608
Baby Walkers                     4946       Tobacco and Smoking in                         Blood Test for Iron             5106
Bedwetting in Children           3706         Children and Teens                    3796   Bone Density Testing            5139
Breast-Feeding Advice            4738       Toddler Discipline                      3779   Bone Marrow Biopsy              5107
Breast-Feeding and Giving                   Toilet Training                         3780   Bone Scan                       5108
  Your Baby Enough Milk          4739       Undescended Testicle                    3783   Bronchoscopy                    4804


                    You can call L.A. Care’s 24-hour nurse advice line at 1-800-249-3619.
                                        You can call this number for free anytime, day or night.                             73
Colonoscopy                           5111    Diet and Exercise                                  Sugar Substitutes                    4727
Colorectal Cancer Screening           5112    Ca eine and Athletic Performance      4107         Swimming and Water Exercise          4155
Colposcopy of the Vagina and Cervix   5113    Ca eine in Your Diet                  4700         Training Heart Rates                 4159
Complete Blood Count Test             5114    Calcium                               4701         Vegetarian Diet                      4731
                                              Carbohydrates                         4702         Vitamins                             4732
Coronary Angiogram                    3616
                                              Circuit Training                      4108         Vitamins and Minerals for Children   4742
CT Scan                               5116
                                              Controlling Cholesterol               3615         Weight Loss Diets                    4733
Cystourethroscopy                     5117
                                              Cross Training                        4109
Diagnostic Laparoscopy                5118
                                              DASH Diet for Hypertension            3654         Digestive System
Echocardiogram                        5119    Eating Healthy Snacks                 4707         Abdominal Pain                       5050
Electrocardiogram or ECG or EKG       5120    Exercise and Weight Control           4117         Acute Pancreatitis                   4000
Electroencephalogram                  5121    Exercise for Kids                     4129         Anal Fissure                         4001
Electromyogram                        5122    Exercise for Older Adults             3013         Anal Fistula                         4002
                                              Exercise for Teens                    3792         Antibiotic-Associated Diarrhea       4041
Endometrial Biopsy                    5230
                                              Exercise to Stay Healthy              4118         Botulism                             4919
Endoscopic Retrograde
                                              Fast Food                             4735         Celiac Disease                       4734
  Cholangiopancreatography            5123
                                              Fiber in Your Diet                    4711         Chronic Pancreatitis                 4005
HIV Tests                             4519
                                              Fluid Needs for Good Health           4743         Cirrhosis                            4006
Hysteroscopy                          5244
                                              Fluid Needs of Older Adults           3014         Constipation                         4008
Intravenous Pyelogram                 5141                                                       Crohn’s Disease                      4009
                                              Fluid Replacement                     4122
Lipid Panel Test                      5110                                                       Diarrhea                             4010
                                              Good and Bad Fats in Your Diet        4709
Liver Panel Test                      5140    Grains in Your Diet                   4712         Diarrhea in Children                 3809
Lumbar Puncture                       3417    Healthy Diet                          4728         Diverticulitis                       4011
Mammogram                             5248    Healthy Meal Planning for Children    3754         Diverticulosis                       4012
MRI or Magnetic Resonance Imaging 5127        Healthy Snacks for Children           4737         Duodenal Ulcer                       4013
                                              Healthy Weight Gain                   4713         Food Poisoning                       4918
Myelogram                             3420
                                              Home Exercise Equipment               4126         Food Poisoning in Children           3815
Newborn Screening Tests               3740
                                              Iron in Your Diet                     4741         Gallstones                           4014
Pap Test                              5129
                                              Keeping a Food Diary                  4730         Gastritis                            4017
Pelvic Exam                           5263                                                       Groin Hernia                         4019
                                              Lactose Intolerance                   4736
Percutaneous Transhepatic                                                                        Heartburn                            4021
                                              Losing Weight                         4714
  Cholangiography                     5130
                                              Low Sodium Diet                       3636         Hemorrhoidectomy                     4022
Prostate Speci c Antigen Screening    3538                                                       Hemorrhoids                          4023
                                              Measuring Body Fat                    4132
Sigmoidoscopy                         5131                                                       Hernias in Children                  3728
                                              Neck Exercises                        3211
Strep Test                            5142    Nutrition for Healthy Aging           3027         Hiatal Hernia                        4027
T4 Test                               5134    Obesity                               4719         Indigestion                          4029
Tests to Diagnose Heart Disease       3652    Personal Fitness Plan                 4112         Intestinal Gas                       4030
     yroid Scan                       5132    Reading Food Labels                   4724         Irritable Bowel Syndrome             4031
                                              Running or Jogging                    4146         Nausea and Vomiting                  5065
TSH Test                              5133
                                              Safe Exercise for People                           Nausea and Vomiting in Children      3819
Ultrasound Scanning                   5135
                                                with Heart Disease                  4164         Polyps in the Colon and Rectum       4007
Urine Culture                         5136    Salt in Your Diet                     4725         Rectal Bleeding                      4035
Urine Tests                           5137    Sports Drinks                         4150         Stomach Flu                          4037
Vital Signs                           4436    Strength Training                     4153         Stomach Ulcer                        4016
X-Rays                                5138    Stretching                            4154         Swallowing Di culty or Dysphagia     5071


                  You can call L.A. Care’s 24-hour nurse advice line at 1-800-249-3619.
74                                    You can call this number for free anytime, day or night.
Traveler’s Diarrhea               4038       Contact Lens Care for                           Fever in Children                       3812
Ulcerative Colitis                4039         Gas Permeable Lenses                   4204   Hiccups                                 4416
                                             Contact Lens Care for
                                               Soft Contact Lenses                    4205
Ear, Nose and Throat                                                                         Genes and Heredity
                                             Crossed or Misaligned                           Down Syndrome                           4314
Assistive Listening Devices for                Eyes or Strabismus                     4207
  the Hearing Impaired            4415                                                       Tay Sachs Disease                       3802
                                             Eye Allergy or Allergic Conjunctivitis   4209
Earache                           3963
                                             Eye Care                                 4210
Earache in Children               3810                                                       Health Promotion
                                             Eye Exam                                 4211
Earwax                            3953                                                       A Healthy Lifestyle for Older Adults    3000
                                             Eye Symptoms Demanding
Hearing Aids                      4414         Immediate Attention                    4212   Bathroom Safety                         4651
Hearing Loss in Adults            3954       Eyeglass Care                            4225   Childproo ng Your Home                  4653
Hearing Loss in Children          3727       Eyelid Cyst or Chalazion                 4213   Drowning Prevention in Children         4656
Laryngitis                        3955       Eyestrain                                4214   Falls Prevention and Home Safety        4670
Ménière’s Disease                 3962       Flashes and Floaters                     4215   Hazards of Smoking                      3332
Middle Ear Infection              3950       Glaucoma                                 4216   Health Changes with Aging               3016
Noise and Hearing Loss            4662       Lazy Eye or Amblyopia                    4217   Home Healthcare                         3017
Nosebleed                         3956       Macular Degeneration                     4228   How to Choose a
                                                                                               Primary Care Provider                 4405
Outer Ear Infection               3951       Pinkeye or Conjunctivitis                4218
                                                                                             Insect Repellent Use                    4945
Ruptured Eardrum                  3957       Presbyopia                               4229
                                                                                             Management of Your Personal Health      4659
Sinus Headache                    3427       Retinal Detachment                       4219
                                                                                             Nicotine Withdrawal                     3376
Sinus Headache in Children        3821       Scratch on the Surface of
                                               the Eye or Corneal Abrasion            4206   Personal Emergency Response Systems     3040
Sinusitis                         3958
                                             Something in Your Eyes                   4220   Routine Healthcare for Men              4672
Snoring                           4817
                                             Stye                                     4221   Routine Healthcare for Women            4673
Sore     roat                     3959                                                       Safe Driving for Older Adults           3041
                                             Sunglasses                               4222
Sore     roat in Children         3822                                                       Safety Eyewear                          4226
                                             Types of Contact Lenses                  4223
Speech and Language Problems      3767                                                       Safety Seats for Children               4674
Speech       erapy for Children   4424       Feet                                            Secondhand Smoke                        4423
Telephone Assistive Devices       4431       Athletic Shoes                           4106   Smokeless Tobacco                       3361
Tinnitus                          5072       Bunion                                   3168   Talking with Your Healthcare Provider   4430
                                             Choosing Shoes at Fit                    3180   Ways to Quit Smoking                    3362
Emergency Medicine                           Flat Feet in Children                    3181
Appendicitis                      4003       Foot Care                                3182   Heart and Blood Vessels
Biological Terrorism Agents       4903       Hammertoe                                3190   Aneurysm                                3600
Carbon Monoxide Poisoning         4944       Heel Pain                                3191   Angina                                  3601
Chemical Terrorism Agents         4907       Ingrown Toenail                          3196   Angioplasty                             3602
Choking                           4909       Morton’s Neuroma                         4133   Aortic Valve Regurgitation              3603
Electric Shock                    4912       Over-Pronation                           3220   Aortic Valve Stenosis                   3604
Heat Illness                      4924       Plantar Fasciitis                        3224   Atherosclerosis                         3605
                                             Plantar Warts                            4863   Atrial Fibrillation                     3606
Eyes                                         Running Shoes                            4147   Cardiac Arrest                          3609
Astigmatism                       4224                                                       Cardiac Rehabilitation                  3610
Cataracts                         4200       General Health                                  Cardiomyopathy                          3611
Color Blindness                   4202       Dehydration                              4910   Congenital Heart Disease                3614
Common Vision Problems            4203       Fever                                    5057   Coronary Artery Disease                 3618


                     You can call L.A. Care’s 24-hour nurse advice line at 1-800-249-3619.
                                         You can call this number for free anytime, day or night.                                      75
Deep Vein rombosis                    3621    Chickenpox in Children                  3805       Strep roat                         3960
Early Warning Signs of a Heart Attack 3624    Chlamydial Infection in Men             4503       Syphilis                           4537
Exercise Test                         3623    Chlamydial Infection in Women           4504       Tetanus                            4538
Heart Attack or Myocardial Infarction 3640    Cytomegalovirus                         5316       Trichomoniasis                     4539
Heart Catheterization                 3625    Dengue Fever and                                   Tuberculosis                       4540
Heart Conditions in Pregnancy         5324      Dengue Hemorrhagic Fever              4507       Viral Infections in Children       3713
Heart Disease and Women               3653    E. Coli Infection                       4920       Viral Meningitis in Adults         3434
Heart Disease Prevention              4660    Ehrlichiosis                            4546       Viral Meningitis in Children       3785
Heart Failure                         3627    Fifth Disease                           4508       West Nile Virus                    4542
Heart Murmur                          3628    Flu or In uenza in Children             3813       Whooping Cough                     3787
Heart Palpitations                    3629    Genital Herpes                          4510       Yeast Infection                    5297
High Blood Pressure                   3631    Genital Warts                           4511
High Cholesterol                      3632    Giardiasis                              4547       Injuries
Holter Monitors                       5126    Gonorrhea                               4512       Achilles Tendon Injury             3150
Infective Endocarditis                3634    Group A Strep Disease                   4513       ACL or Anterior Cruciate
                                              H1N1 or Swine Flu                       4560         Ligament Injury                  3153
Low Blood Pressure                    3635
                                              H1N1 or Swine Flu in Children           3816       Animal and Human Bites             4900
Mitral Valve Prolapse                 3637
                                              Hand-Foot-and-Mouth Disease             4514       Ankle Sprain                       3152
Mitral Valve Regurgitation            3638
                                              Helicobacter Pylori                     4042       Baseball Finger or Mallet Finger   3208
Mitral Valve Stenosis                 3639
                                              Hepatitis A                             4024       Broken Ankle                       3164
Myocarditis                           3641
                                              Hepatitis B                             4025       Broken Arm or Forearm Fracture     3260
Pacemakers                            3642
                                              Hepatitis C                             4026       Broken Collarbone                  3257
Paroxysmal Supraventricular
  Tachycardia or PSVT                 3643    Herpes Encephalitis                     4515       Broken Elbow                       3165
Pericarditis                          3644    HIV and AIDS Risk Factors                          Broken Finger                      3166
Peripheral Artery Disease             3645      and Prevention                        4500       Broken Toe                         3258
Pulmonary Embolism                    4812    HIV Infection and AIDS                  4516       Broken Wrist                       3167
Super cial rombophlebitis             3648    HIV Infection from Blood Transfusions    4517      Bruise                             4905
Triglycerides                         3649    Human Papillomavirus                    4520       Bruised Hip or Hip Pointer         3262
Varicose Veins                        3650    Infectious Mononucleosis                4521       Burn and Scald Prevention          4669
Ventricular Tachycardia               3651    Legionnaires’ Disease                   4523       Burns                              4915
                                              Lice                                    4524       Collapsed Lung Caused by Injury    4807
Hormones                                      Listeriosis                             4548       Concussion                         3406
Hyperthyroidism                      3914     Lyme Disease                            4525       Cuts, Scrapes, and Scratches       4934
Hypothyroidism                       3916     Measles                                 4550       Dislocated Elbow                   3176
Pituitary Tumors                     3918     Mumps                                   4551       Electric Shock Prevention          4913
                                              Pelvic In ammatory Disease              5264       Finger Dislocation                 3178
Infectious Disease                            Pinworms                                4526       Finger Sprain                      3179
Anthrax                              4901     Rabies                                  4549       Fracture Treatment                 3185
Antibiotic-Resistant Infections      4552     Rheumatic Fever                         4527       Frostbite                          4922
Bacterial Meningitis in Adults       3402     Roseola in Children                     4529       Golfer’s Elbow                     3261
Bacterial Meningitis in Children     3705     Rubella                                 4530       Groin Strain                       4123
Bird Flu                             4543     Salmonellosis                           4509       Hamstring Strain                   4125
Bone Infection                       3162     Seasonal Flu                            4522       Head Injury                        3413
Cat Scratch Disease                  4544     Sexually Transmitted Diseases           4533       Hip Fracture                       3193
Chickenpox                           4545     Shingles                                4534       Hip Fracture Prevention            3030


             You can call L.A. Care’s 24-hour nurse advice line at 1-800-249-3619.
76                                    You can call this number for free anytime, day or night.
Hypothermia                            4927       Chronic Bronchitis                     4805    Nitroglycerin and Other Nitrates   4269
Hypothermia in Older Adults            3020       Chronic Obstructive                            Nonprescription Medicines          4270
Insect Bites and Stings                3105         Pulmonary Disease                    4806
                                                                                                 Sedatives                          4275
Jumper’s Knee                          3197       Collapsed Lung Not Related to Injury   4808
                                                                                                 Sleeping Pills                     4271
Knee Cartilage Tear or Meniscal Tear   3200       Common Cold                            4506
                                                                                                 Statins                            4279
Knee Sprain                            3202       Common Cold in Children                3806
                                                                                                 Talking with Your Provider
Lateral Collateral Ligament Sprain     3264       Cough                                  4809      about Your Medicines             4256
Little Leaguer’s Elbow                 3265       Cough in Children                      3807
                                                                                                 Using Medicines Safely             4268
Medial Collateral Ligament Sprain      3266       Cystic Fibrosis                        4310
                                                                                                 Vasodilators                       4276
Muscle Strain                          3210       Emphysema                              4810
Neck Injuries                          3212       Peak Flow Meter                        4821    Men’s Health
Neck Stinger                           4136       Pleurisy                               4820
                                                                                                 Enlarged Prostate                  4600
Neck Strain                            3214       Pneumonia                              4811
                                                                                                 Prostate Problems                  4607
Nose Injury                            3270       Pulmonary Function Tests               4813
                                                                                                 Testicular Self-Exam               4611
Overuse Injuries                       4139       Respiratory Syncytial Virus or RSV     3794
                                                                                                 Vasectomy                          4343
Pulled Elbow in Children               3227       Sleep Apnea                            4815
                                                                                                 Vasectomy Reversal                 4331
Puncture Wound                         4929          oracentesis                         4818
Rotator Cu Injury                      3229       Using Oxygen at Home                   4819
                                                                                                 Mouth and Teeth
Runner’s Knee                          3230
                                                  Medications                                    Bad Breath                         3850
Shin Pain or Shin Splints              4148
                                                  ACE Inhibitors                         4250    Canker Sore                        4853
Shoulder Dislocation                   3236
Shoulder Injuries                      3237       Anabolic Steroids                      4103    Canker Sores in Children           3804
Shoulder Separation                    3239       Antacids                               4251    Choosing a Dentist                 3851
Snakebite                              4936       Antibiotics                            4252    Cold Sores or Fever Blisters       4505
Spider Bites and Scorpion Stings       4939       Anticoagulants and Antiplatelets       4277    Dental Care for Adults             3856
Spinal Cord Injury                     3429       Antidepressant Medicines               4253    Dental Care for Children           3852
Splinter                               4940       Antidiarrheal Medicines                4254    Dental Care for Older Adults       3009
Sprains                                3245       Anti-In ammatory Medicines             4255    Denture Care                       3854
Stress Fractures                       3246       Beta Blockers                          4257    Gingivitis                         3855
Tendonitis                             4157       Calcium Channel Blockers               4258    Periodontal Disease                3857
Tennis Elbow                           3248       Corticosteroids                        4259    Teeth Grinding in Children         3860
   umb Sprain                          3249       Cortisone Injection                    4278    Teething                           3774
Tick Bite                              4943       Cough Medicine, Nonprescription        4260    Temporomandibular Joint Disorder   4432
Using Crutches Safely                  3253       Cough Medicines and Children           3808
                                                                                                    rush                            3858
Wound Closure and Wound Care           5015       Decongestants and Antihistamines       4261
                                                                                                 Toothache                          3859
Wrist Sprain                           3255       Diuretics                              4262
                                                  Drug Interactions                      4263
                                                                                                 Pain Management
Lungs                                             Fertility Drugs                        4319
                                                                                                 Alternative Ways to Control Pain   4438
Acute Bronchitis                       4800       Generic and Brand-Name Drugs           4264
Altitude Sickness                      4401                                                      Anesthesia                         5000
                                                  High Blood Pressure Medicines          4266
Asthma                                 4801                                                      Chronic Pain                       4440
                                                  Laxatives                              4267
Asthma and How to Use Inhalers         4822                                                      Knee Pain                          3263
                                                  Medicine Safety in Children            3735
Asthma in Children                     3701                                                      Neuralgias or Neuropathic Pain     3422
                                                  Medicine-Related Problems
Asthma Inhalers for Children           3803         for Older Adults                     3026    Noncardiac Chest Pain              3612
Breathing Exercises                    4802       Medicines to Keep on Hand              4273    Patient-Controlled Analgesia       3536


                  You can call L.A. Care’s 24-hour nurse advice line at 1-800-249-3619.
                                              You can call this number for free anytime, day or night.                                77
Physical and Sports Medicine                   Induction of Labor                    5302         Sexual and Reproductive Health
Deep Heat Treatment                    4113    Injury during Pregnancy               5344         Birth Control Methods               4302
Electrical Nerve Stimulation           4116    Labor and Delivery                    5247         Birth Control Patch                 4303
Ice erapy                              4127    Later Childbearing                    5328         Birth Control Pills                 4304
Low Back Exercises                     3204    Leg Cramps during Pregnancy           5329         Cervical Cap                        4306
Occupational erapy                     4419    Leg Numbness during Pregnancy         5330         Depo-Provera                        4311
Physical erapy                         3222    Low Back Pain during Pregnancy        5331         Diaphragm                           4312
RICE or Rest, Ice, Compression,                Mental Illness during Pregnancy       5332         Early Puberty in Boys               3919
  and Elevation for Injuries           3271    Miscarriage                           5252         Early Puberty in Girls              3920
Ultrasound Treatment                   3252    Morning Sickness                      5254         Erectile Dysfunction                4601
                                               Natural Family Planning               4326         Female Condom                       4317
Pregnancy                                      Nonreassuring Fetal Status            5300         Tubal Ligation                      4318
Amniocentesis                          5202    Nonstress Test                        5305         Homosexuality and Teens             3730
Beta Strep during Pregnancy            5301    Normal Growth of a                                 In Vitro Fertilization              4322
Blood Tests for Birth Defects          5308      Baby during Pregnancy               5257
                                                                                                  Infertility                         4323
Breast Care If You Choose                      Pain in the Vagina during Pregnancy   5339
  Not to Breast-Feed                   5313                                                       IUD                                 4324
                                               Pain Relief in Labor and Delivery     5306
Cesarean Section                       5216                                                       Male Condom                         4325
                                               Physical Abuse During Pregnancy       5334
Chickenpox during Pregnancy            5315                                                       Morning-After Pill or
                                               Postpartum Care                       5267           Emergency Birth Control           4315
Child Spacing                          4307
                                               Pregnancy and Weight Control          5335         Painful Intercourse                 5262
Choosing a Healthcare
  Provider for Your Pregnancy          5217    Pregnancy Tests                       5271         Pregnancy Prevention for
Chorionic Villus Sampling              5218    Prenatal Care                         5274           Young Men and Women               3755
Contraction Stress Test                5312    Prenatal Tests                        5275         Premature Ejaculation               4606
Counseling during Pregnancy            5319    Preterm Labor                         5309         Puberty for Boys                    3757
Danger Signs in Pregnancy              5221    Rh Incompatibility                    5311         Puberty for Girls                   3758
Diabetes in Pregnancy                  5223    Round Ligament Pain in Pregnancy      5338         Rape                                4930
Diet during Pregnancy                  5225    Ruptured Membranes                    5277         Sensual Touch                       4434
Drinking Fluids during Pregnancy       5323    Sex during Pregnancy                  5278         Sex erapy                           3359
Drug, Alcohol, and Tobacco Use                 Skin Changes during Pregnancy         5281         Sexual Abstinence                   4332
  During Pregnancy                     5227    Slowed Growth of Baby                              Sexual Problems                     3378
Ectopic Pregnancy                      5228      during Pregnancy                    5340         Sexual Response in Men              4610
Emotional Stress or                            Smoking during Pregnancy              5282         Sexual Response in Women            5280
  Depression during Pregnancy          5321    Surgery to Close the Cervix           5341         Sexuality in the Later Years        3034
Episiotomy                             5232    Swelling in the Hands                              Sexually Transmitted
Estimating Gestational Age             5299      and Feet during Pregnancy           5342           Disease Prevention                3756
Exercise after Delivery                5233    Teen Pregnancy                        4341         Spermicides                         4336
Exercise during Pregnancy              5234    Toxoplasmosis during Pregnancy        5343         Talking with Your Child about HIV   4339
Genetic Screening Before                       Travel When You Are Pregnant          5287         Talking with Your Teen about Sex    4340
  or During Pregnancy                  5240
                                               Trouble Breathing during Pregnancy    5322         Tubal Sterilization Reversal        4330
Getting Ready for Pregnancy            5241
                                               Trouble Sleeping during Pregnancy     5345         Vaginal Contraceptive Ring          4342
Heartburn during Pregnancy             5325
                                               Types of Baby Movements               5346
High Blood Pressure during Pregnancy   5270
                                               Urinary Frequency during Pregnancy    5347         Skin
Household or Chemical
  Exposure during Pregnancy            5326    Vision Changes during Pregnancy       5349         Acne                                4850
How Long Should I Stay                         Working during Pregnancy              5296         Athlete’s Foot                      3160
  in the Hospital after Delivery?      5327    X-Rays during Pregnancy               5310         Blisters                            4851


             You can call L.A. Care’s 24-hour nurse advice line at 1-800-249-3619.
78                                     You can call this number for free anytime, day or night.
Boils and Carbuncles           4852       Social and Family                                Hip Replacement Surgery                   3195
Botox Treatment of Wrinkles    4439       Adoption                                 4300    Implantable Cardioverter
Cellulitis                     4854                                                          De brillator or ICD                     3633
                                          Adult Day Care Programs                  3002
Contact Dermatitis             3106                                                        Knee Replacement Surgery                  3201
                                          Advance Directives                       3003
Corns and Calluses             3174                                                        Laparoscopic Cholecystectomy              4032
                                          Caring for People with
Dandru                         4857         Progressive Dementia                   3431    LASIK                                     4227
Diaper Rash                    3718       Caring for Someone with                          Liposuction                               5008
Eczema                         3108         Alzheimer’s Disease                    3404    Lumpectomy and Removal
                                          Common Problems of New Mothers            5317     of Lymph Nodes                          5013
Excessive Hair Growth          4410
                                          Communicating with Your Teen             4309    Nose Reconstruction                       5009
Facelifts                      5006
                                          Communication in                                 Setting a Broken Bone Without Surgery     3234
Fungal Infection of a Nail     4876
                                            Intimate Relationships                 4407    Shoulder Replacement Surgery              3238
Hair Loss in Men               4602
                                          Con ict Management                       3372    Spinal Fusion                             3242
Hair Loss in Women             5242
                                          Finding and Choosing Child Care          3791    Spinal Instrumentation                    3243
Impetigo                       4860
                                          Healthy Families                         4316    Surgery to Set a Broken Bone              3247
Itching                        4861
                                          Hospice                                  4418    Tonsil and Adenoid Removal                3961
Itching in Children            3818
                                          How to Choose a Nursing Facility         3019    Tonsil and Adenoid
Jock Itch                      4875
                                          Informed Consent                         4308      Removal in Children                     3824
Moles                          4862
                                          New Father                               3722    Tracheotomy                               5014
Pilonidal Disease              4878
                                          New Mother                               3736    Transurethral Resection of the Prostate   4608
Pressure Ulcers                4874
                                          Normal Development                               Tummy Tuck                                5011
Psoriasis                      4864
                                            18 to 24 Months Old                    3744    Vaginal Hysterectomy                      5291
Rashes in Infants              3759
                                          Pets and Older Adults                    3028
Ringworm                       4528
                                          Preparing for the First Day of School    3795    Urinary System
Rosacea                        4865
                                          Senior Centers                           3033    Acute Kidney Failure                      5350
Scabies                        4531
                                          Sibling Relationships                    4333    Bladder Infection                         5351
Seborrhea                      4866
                                          Single Parenting                         4335    Blood in Urine                            5352
Skin Care for Older Adults     3035
                                                                                           Chronic Kidney Failure                    5353
Skin Exam                      4869
                                          Surgery                                          Cystocele                                 5320
Skin Infection Around
   a Fingernail or Toenail     4877       Abdominal Hysterectomy                   5200    Functional Urinary Incontinence           5354
Skin or Soft Tissue Abscess    4870       Arthroscopic Meniscal Surgery            3156    Indwelling Catheter Care                  5355
Skin Resurfacing               5010       Breast Enlargement Surgery               5002    Kegel Exercises                           5356
Sunburn                        4871       Breast Reconstruction Surgery            5003    Kidney Dialysis                           5367
Sunburn in Children            3823       Breast Reduction Surgery                 5004    Kidney Infection                          5357
Tanning Beds                   4872       Cataract Surgery                         4201    Kidney Stones                             5358
Warts                          4873       Cholecystostomy                          4004    Lithotripsy for Kidney Stones             5359
Warts in Children              3825       Colostomy and Ileostomy                  4028    Over ow Incontinence                      5360
                                          Cone Biopsy of the Cervix with a Laser   5298    Stress Incontinence in Women              5284
Sleep Disorders                           Coronary Artery Bypass Surgery           3617    Urge Incontinence                         5361
Insomnia                       5060       Cryosurgery                              5012    Urinary Catheterization                   5362
Insomnia in Older Adults       3021       D&C                                      5220    Urinary Incontinence                      5363
Jet Lag                        4442       Eyelid Surgery or Blepharoplasty         5005    Urinary Obstruction                       5364
Narcolepsy                     3421       Gallbladder Removal                      4015    Urinary Tract Infection in Men            5365
Nightmares and Night Terrors   3344       Gastrostomy Feeding Tube Placement       4018    Urinary Tract Infection in Women          5366
Sleep Disorders in Children    3766       Heart Transplant                         3630    Urination Problems                        5074


                You can call L.A. Care’s 24-hour nurse advice line at 1-800-249-3619.
                                      You can call this number for free anytime, day or night.                                         79
Women’s Health
Atrophic Vaginitis                     5203
Bartholin’s Gland Cyst                 5204
Benign Ovarian Tumor                   5205
Bleeding Between Menstrual Periods     5209
Breast Infection                       5210
Breast Self-Exam                       5211
Breast Tenderness                      5314
Cervical Intraepithelial Neoplasia     5213
Cervical Polyp                         5214
Cervicitis                             5215
Endometriosis                          5231
Feminine Hygiene                       5237
Fibrocystic Breast Changes             5239
Galactorrhea                           5256
Heavy or Extended Menstrual Bleeding   5303
Hot Flashes                            5243
Menopausal Hormone erapy               5249
Menopause                              5250
Menstrual Cramps                       5251
Midcycle Pain                          5333
Missed Menstrual Periods               5253
Missed Menstrual Periods
  or Amenorrhea due to Exercise        4105
Ovarian Cysts                          5259
Pelvic Support Problems                5265
PMS or Premenstrual Syndrome           5273
Polycystic Ovary Syndrome              5307
Postmenopausal Bleeding                5266
Premenstrual Dysphoric Disorder        5272
Rectocele                              5337
Sore Nipples                           5304
Tipped Uterus                          5285
Uterine Fibroids                       5288
Uterine Prolapse                       5348
Vaginitis                              5293
Vulvar Dystrophy                       5294
Vulvitis                               5295




            You can call L.A. Care’s 24-hour nurse advice line at 1-800-249-3619.
80                                     You can call this number for free anytime, day or night.
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       555 West Fifth Street
Los Angeles, CA 90013-3036

            www.lacare.org

  Toll Free: 1-888-839-9909
       TTY: 1-866-522-2731




                   LA0262 08/10

				
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