You do not have to pay for covered services unless you have a share of cost for long-term care. To learn more about members with long-term care and a share of cost, visit the Costs section of this online handbook. 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 card when you get health care services or prescriptions, so your provider knows who to bill. You can 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).
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.
Tell L.A. Care the amount you are being charged, the date of service, and the reason for the bill. L.A. Care will help you figure out if the bill was for a covered service or not. You do not need to pay providers for any amount owed by L.A. Care for any covered service. If you get care from an out-of-network provider and you did not get pre-approval (prior authorization) from L.A. Care, you might have to pay for the care you got.
You must get pre-approval (prior authorization) from L.A. Care before you visit an out-of-network provider except when:
- 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 (prior authorization)
- You need mental health services, in which case you can go to an in-network provider or to a county mental health plan provider without pre-approval (prior authorization)
If you need to get medically necessary care from an out-of-network provider because it is not available in the L.A. Care network, you will not have to pay as long as the care is a Medi-Cal covered service and you got pre-approval (prior authorization) from L.A. Care for it.
To learn more about emergency care, urgent care, and sensitive services, visit the sections of this online handbook listed below:
If you get a bill or are asked to pay a co-pay you do not think you 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 in writing about the item or service you paid for. L.A. Care will read your claim and decide if you can get money back.
For questions call Member Services at 1-888-839-9909 (TTY 711).
If you get services in the Veterans Affairs system or get non-covered or unauthorized services outside of California, you might 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 ask to be paid back for Medicare Part D co-pays for prescriptions covered by your Medicare Part D plan.