How to See a Doctor
You may choose the doctor or clinic you already use, if the doctor or clinic participates with CommuniCare Advantage, a Medicare Medi-Cal 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, and has helpful information about each doctor and clinic.
If there is a particular CommuniCare Advantage 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 Member Services 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 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’s Member Services Department if you would like one sent to you at 1-888-244-4430 (TTY 1-855-266-4584). CommuniCare Advantage 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 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 (HMOD-SNP) is an HMO D-SNP health plan with a Medicare contract and a contract with the Medi-Cal program. Enrollment in CommuniCare Advantage depends on contract renewal.
ATTENTION: If you speak another language, language assistance services, free of charge, are available to you. Call 1-888-244-4430 , TTY users should call 1-855-266-4584, 24 hours a day, 7 days a week. The call is free.
PANSININ: Kung nagsasalita kayo ng ibang wika, may mga paglingkod na pagtulong sa wika na maabot ninyo, na libre. Tawagan ang 1-888-244-4430 (TTY: 1-855-266-4584). Liber ang tawag na ito.
1-888-244-4430 تنبيه: إذا كنت تتحدث اللغة العربية ، فأن خدمات المساعدة اللغوية متاحة لك بدون اي مقابل. إتصل بالرقم :
1-855-266-4584او الهاتف النصي :
كلا الرقمين متوفرين ٢٤ ساعة باليوم ٧ أيام بالاسبوع.
توجه: اگر به زبان فارسی صحبت میکنید، خدمات کمک زبانی، به صورت رایگان، در اختیار شماست. با 4430-244-888-1 (پیامنگار: 1-855-266-4584) تماس بگیرید. تماس با این شمارهها رایگان است.
Last Website Update 09/14/2023