How to See a Doctor
You may choose the doctor or clinic you already use, if the doctor or clinic participates with CommuniCare Advantage Cal MediConnect Plan.Or you may choose a new doctor from the Provider Directory. The Provider Directory gives you a listing of all medical groups, Primary Care Physicians (PCPs), specialists and hospitals contracted with CommuniCare Advantage Cal MediConnect Plan, and has helpful information about each doctor and clinic.
If there is a particular CommuniCare Advantage Cal MediConnect plan specialist or hospital that you want to use, check first to be sure your PCP belongs to the same medical group as that specialist, and uses that hospital. The name and office telephone number of your PCP is printed on the membership card.
You may also change your PCP at any time. Call Customer Service to choose a PCP or to change your PCP.
How do you get care from your PCP?
To see your PCP doctor, call your PCP doctor's office to make an appointment. Your PCP’s phone number is printed on your CommuniCare Advantage Cal MediConnect Plan membership card.
We recommend that you make sure to see your PCP for preventive care and see your PCP at least annually, not just when you are sick or have an immediate need.
How do you get care from specialists and hospitals?
When your PCP thinks that you need specialized treatment, he/she will give you a referral (approval in advance) to see a plan specialist. A specialist is a doctor who provides health care services for a specific disease or part of the body.
You must get a referral before you get specialized health care or treatment at a hospital (except for emergency care, urgent care, or to see an Ob/Gyn). If you don’t have a referral (approval in advance) before you get services from a specialist, you may have to pay for these services yourself.
See our Provider/Pharmacy Directory for the most current listing of Providers in our contracted Network. Call CommuniCare Advantage Cal MediConnect Plan Customer Service Department if you would like one sent to you at 1-888-244-4430 (TTY 1-855-266-4584). CommuniCare Advantage Cal MediConnect plan representatives are available 24 hours a day, 7 days a week, including holidays.
The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year. We will send you a notice before we make a change that affects you.
Out-Of-Network Medical Coverage
With limited exceptions, while you are a member of our plan you must use network providers to get your medical care and services. The only exceptions are emergencies, urgently needed care when the network is not available (generally, when you are out of the area), out-of-area dialysis services, and cases in which CommuniCare Advantage Cal MediConnect Plan authorizes use of out-of-network providers.
You are responsible for paying the full cost of services that were obtained out-of-network where not authorized.
Please refer to your Member Handbook for full information on out-of-network medical coverage.
CommuniCare Advantage Cal MediConnect Plan is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. Enrollment in CommuniCare Advantage Cal MediConnect Plan depends on contract renewal.
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook.
Limitations, copays and restrictions may apply. For more information, call CommuniCare Advantage Cal MediConnect Customer Service or read the CommuniCare Advantage Cal MediConnect Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change on January 1 of each year.
Copays for prescription drugs may vary based on the level of Extra Help you receive. Please contact the plan for more details.
ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-888-244-4430 (TTY: 1-855-266-4584).
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-888-244-4430 (TTY: 1-855-266-4584).
ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-888-244-4430 (TTY: 1-855-266-4584).
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-888-244-4430 (TTY: 1-855-266-4584).
ملحوظة:4584-266-855-1) إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم (4430-244-888-1) رقم هاتف الصم والبكم ).
Last update February 28, 2017
H5172_Website2017 Approved 1/17/17