Out-of-network providers are health care providers that do not have an agreement to work with L.A. Care. Except for emergency care, you might have to pay for any care you get from out-of-network providers. If you need medically necessary health care services that are not available in the network, you might be able to get them from an out-of-network provider at no cost to you.
L.A. Care may approve a referral to an out-of-network provider if the services you need are not available in-network or are located very far from your home. If we give you a referral to an out-of-network provider, we will pay for your care.
For urgent care inside the L.A. Care service area, you must go to a L.A. Care in-network urgent care provider. You do not need pre-approval (prior authorization) to get urgent care from an in-network provider. You do need to get pre-approval (prior authorization) to get urgent care from an out-of-network provider inside the L.A. Care service area.
If you get urgent care from an out-of-network provider inside L.A. Care service area, you might have to pay for that care.
Find more information on these topics visit the sections of this handbook listed below:
Note: If you are an American Indian, you can get care at an IHCP outside of our provider network without a referral. An out-of-network IHCP can also refer American Indian members to an in-network provider without first requiring a referral from an in-network PCP.
If you need help with out-of-network services, call L.A. Care Member Services at 1-888-839-9909 (TTY: 711).
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