You do not have to pay for covered services. In most cases, you will not get a bill from a provider. You must show your L.A. Care ID card and your Medi-Cal BIC when you get any health care services or prescriptions so your provider knows who to bill. You may get an Explanation of Benefits (EOB) or a statement from a provider. EOBs and statements are not bills.
If you do get a bill, call Member Services at 1-888-839-9909 (TTY: 711). Tell L.A. Care the amount charged, the date of service and the reason for the bill.
You are not responsible to pay a provider for any amount owed by L.A. Care for any covered service.
If you get a bill for prescriptions, call Medi-Cal Rx at 1-800-977-2273 (TTY 800-977-2273 and press 7 or 711) or visit the Medi-Cal Rx website.
You must get pre-approval (prior authorization) from L.A. Care before you visit a provider outside the L.A. Care network, including inside the L.A. Care service area, except in the following situations:
- You need emergency services, in which case dial 911 or go to the nearest hospital
- You need family planning services or services related to testing for sexually transmitted infections, in which case you can go to any Medi-Cal provider without pre-approval
- You need mental health services, in which case you can go to either an in-network provider or a county mental health plan provider without pre-approval
If you do not get pre-approval, you may have to pay for care from providers who are not in the network.
If you need covered health care services, you may be able to get them at an out-of-network provider at no cost to you, as long as they are medically necessary, not available in the network and pre-approved by L.A. Care.
For more information about these services, visit the:
sections of this handbook.
If you get a bill or are asked to pay a co-pay that you think you did not have to pay, call Member Services at 1-888-839-9909 (TTY: 711).
If you pay the bill, you can file a claim with L.A. Care. You will need to tell L.A. Care why you had to pay for the item or service. L.A. Care will review your claim and decide if you can get money back. For questions call Member Services at 1-888-839-9909 (TTY 711).
If you receive services in the Veterans Affairs system or non-covered or unauthorized services received outside of California, you may be responsible for payment.
L.A. Care will not pay you back if:
- The services are not covered by Medi-Cal such as cosmetic services.
- You have an unmet Medi-Cal Share of Cost.
- You went to a doctor who does not take Medi-Cal and you signed a form that said you want to be seen anyway and you will pay for the services yourself.
- You asked to be paid back for co-pays for prescriptions covered by your Medicare Part D plan.