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Who can I call with questions, concerns, or
complaints?
Our Member Service Department is available
to assist you. Call us at 1-800-605-2556, Monday through Friday,
8:00 a.m. to 6:00 p.m. Our staff is comprised with Member Representatives
that speak, English, Spanish, Armenian and Russian, and can answer
any questions that you may have in regards to your health plan benefits.
If you speak another language Care1st Health Plan can also assist
you through the use of one of our translators.
Please remember that you may also speak to your
primary care doctor about your medical concerns. Your primary care
doctor and his/her staff are there to help.
The California Department of Managed Health Care
is responsible for regulating health care service plans. The department
has a toll-free telephone number (1-888-HMO-2219) to receive complaints
regarding health plans. The hearing and speech impaired may use
the California Relay Service's toll-free numbers (1-800-735-2929
(TTY) or 1-888-877-5378 (TTY)) to contact the department. The department's
web site www.hmohelp.ca.gov
has complaint forms online. If you have a grievance against your
health plan, you should first contact Care1st Member Services Department
at 1-800-605-2556, or 1-800-479-3310 (TTY) for the hearing and speech
impaired, and use the plan's grievance process before contacting
the department. If you need help with a grievance involving an emergency,
a grievance that has not been satisfactorily resolved by your plan,
or a grievance that has remained unresolved for more than 30 days,
you may call the department for assistance. The plan's grievance
process and the department's complaint review process are in addition
to any other dispute resolution procedures that may be available
to you, and your failure to use these processes does not preclude
your use of any other remedy provided by law. [
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Can
I change my Primary Care Doctor?
Yes. As a member of Care1st, we want you to be comfortable with
your assigned primary care doctor. Care1st has a large group of
doctors for you to choose from. You may change your doctor by calling
our Member Services Department at 1-800-605-2556. A change of doctor
can be requested at any time, but it can take up to 30 days for
the change to take effect. [ top
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Why
do I need a Primary Care Doctor?
Care1st wants to make sure that you get the best quality care and
service. This is why a Primary Care Doctor is assigned to you. This
Primary Care Doctor will be your own personal doctor. Your Primary
Care Doctor will be responsible for all of your medical care and
for referring you to another doctor when needed. [
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When
do I receive my Welcome Packet?
When you become a member of Care1st, you will receive a "Welcome
Packet" within the first 7 days of eligibility. The "Welcome
Packet" will include a welcome letter, Provider Directory,
Evidence of Coverage, and your Care1st ID card. Carry your Care1st
ID card with you when visiting your doctor, filling your prescriptions,
or getting care from a hospital emergency room. The Care1st ID card
identifies you as a member of Care1st. Remember to also carry with
you your white Medi-Cal Beneficiary Identification Card (BIC). This
card determines your Medi-Cal eligibility status. Please remember
to keep these ID cards in a safe place and never let anyone else
use your Care1st ID card or BIC card. [
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How
can I join Care1st?
Enrollment for Care1st is processed by Health Care Options (HCO).
You may contact them directly at 1-800-430-4263. HCO will mail you
an enrollment packet that you will need to fill out and mail back
to them. Once HCO receives your packet, it takes 15 to 45 days for
you to become a member of Care1st.
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What
do I do if I need Vision Care?
For information on how to obtain Vision Care, call Care1st Member
Service Department at 1-800-605-2556 so that they can assist you
with the right information. [ top
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Does
Care1st offer transportation?
Emergency transportation is available
to you in life-threatening situations. You may call 911 directly
and an ambulance will be sent to you. Please remember that ambulances
are for life threatening emergencies only and should not be used
for routine medical care. You may be responsible for services if
you use an ambulance for non-emergency conditions.
For routine medical appointments or non-urgent
medical care, Care1st Member Services Department can help you
get
transportation. Care1st offers transportation to and from your
doctor’s
office when you have no other means of getting there. To schedule
transportation, you must call Care1st Member Service Department
at 1-800-605-2556 one-day in advance. [ top
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How
can I obtain specialty care?
All specialty care, except for OB/GYN services, must be scheduled
for you by your primary care doctor. Your primary care doctor is
responsible for making sure that you receive the necessary medical
care services. [ top
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What
do I do if I am out of my service area and need to see a doctor?
In case of a life-threatening emergency, go to the nearest hospital
or call 911 immediately. [ top
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Where
can I find on-line health & medical advice and information?
If you want to gain access to tools, libraries
and all kinds of articles, features, activities, etc -- take a look
at "My Health Zone". [ top ]
What if I am a Medi-Cal member and also have Medicare,
how do I obtain my medicine?
If you are a Medi-Cal
member with Medicare also, it is important that you know that Medicare,
not Medi-cal, will
pay for most
of your prescription drugs. For more information please contact
Care1st
Health Plan’s Member Service Department at 1-800-605-2556
or you can call Medicare at 1-800-Medicare. TTY users call
1-877-486-2048. You can also visit the Medicare website at
www.Medicare.gov. [ top ]
Does Care1st offer 24 hour interpreter services?
Care1st members can obtain telephone interpreter
services at no cost, 24 hours a day, 7 days a week by calling Care1st
Member Services Department at 1-800-605-2556. For face to face
interpreter services, you must call the Member Services Department
at least 5 days before your scheduled appointment. This includes
sign language. For Providers, click here. [ top ]
How do I obtain information about practitioners who participate in the organization?
You may have questions that are not answered by our provider directory. You can call our Member Services Department at 1-800-605-2556 and get information such as:
- Doctors office hours
- Languages the doctor or staff speak
- Is the doctor a man or a woman
- How long have they been practicing
- Medical training history
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How do I obtain behavioral health services?
Medi-Cal members who require behavioral health services can contact the Department of Mental Health’s Local 24 hour crisis line at:
Los Angeles: 1-800-854-7771
San Diego: 1-800-479-3339
The Department of Mental Health also has a suicide prevention hotline at 1-800-273-8255
Medicare members please contact CompCare at 1(877) 224-7506
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How do I obtain care after normal business hours?
It is important you always carry your Care1st ID card with you. If you think you have an emergency, call 911 or go to the nearest emergency room. Call your doctor if you need medical care and he or she can help you arrange care. If your doctor is not available call 1-800-605-2556 and we will help you. [ top ]
How does your organization evaluate new technology for inclusion as a covered benefit?
Care1st Health Plan understands that health care is changing every day. There are new treatments being developed all the time. Care1st Health Plan looks at these new treatments all the time to decide how safe they are. We also look to see if they could help our members.
Care1st has a committee to look at new medicines. We have another committee to look at new treatments. These committees include doctors from all different specialties. It also includes medical directors. The committee:
- Looks at new medicines and treatments
- Keeps patient safety as the number one goal
- Looks to see if the government has approved the new treatment
- Looks to see if there are good studies that show a real benefit
- Looks to see if the treatment helps as much or more that treatments already approved
- Looks to see if the new treatment helps the overall health of the patient
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How can I obtain information about co-payments ad other charges for which I am responsible?
Care1st Health Plan has various plan options, which include different co-payments depending on your specific plan. This information is in the annual Evidence of Coverage (EOC) that is mailed to each member annually. If you wish to look at the Evidence of Coverage for your specific plan please click on your plans link below:
Medicare Advantage Plans
Special Needs Plans
Healthy Families
Medi-Cal
Medi-Cal Dental
Commercial
There are no co-pays for Medi-Cal members. If you have questions about your benefits or co-payments please contact Member Services at 1-800-605-2556 and we will be glad to answer your questions.
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How can I be sure my medical information is protected?
You have the right to review your medical records at any time upon request. Your doctor can give you a copy. Your doctor, all specialists and hospitals must keep your medical information private. Care1st only uses your medical information for health care operations (payment of claims, quality improvement, authorizations, etc.). Any non-routine use of you medical information needs your written permission. This means you would need to sign a consent form. Your doctor must keep your record safe, away from non-staff members and locked when not in the office. Care1st gives members a Notice of Privacy Practices every year. You can get a copy if you call 1800-605-2556.
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How can I obtain materials in my language?
Information in the language you understand can be obtained by calling Care1st Cultural & Linguistics (C&L) Department at 1-800-605-2556.
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How can I obtain materials in an alternative format (Braille, Audio, etc.)?
Information in an alternative format is available to Care1st members upon request. Form more information please contact Care1st Cultural & Linguistic Department at 1-800-605-2556.
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How can I obtain more information about available community based programs and services?
Care1st offers referrals services at no cost to you. This includes referrals to cultural and linguistically appropriate services/agencies or community based organizations in your area. Social services, support groups, immigration services, legal services, shelter, interpreter services, etc. For more information please call Care1st Cultural and Linguistic Department at 1-800-605-2556.
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