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Medi-Cal

Medi-Cal is California's Medicaid program. This is a public health insurance program. It provides health care services for people with low incomes. People served include:

  • Low income individuals
  • Families with children
  • Seniors
  • People with disabilities
  • Children in foster care
  • Pregnant women
  • People with specific diseases such as breast cancer, tuberculosis or HIV/AIDS.

Anthem Blue Cross’ affiliate is contracted with the Department of Health Care Services to provide Medi-Cal health benefits to its Medi-Cal recipients. Anthem Blue Cross is also contracted with the Local Initiative Health Authority of Los Angeles County (L.A. Care).

Benefits Overview

We provide all of your regular Medi-Cal benefits, plus many extras. For a full list, please see our member handbook. For a few highlights, read on:

  • Checkups at no cost
  • 24/7 NurseLine — a 24/7 nurse helpline so you can get help when you need it
  • Rides to approved medical services and visits at no cost
  • No-cost Telehealth services. Telehealth services are when you make an appointment with your regular doctor, and you work with a specialist at another location over the phone, through computers or other technology to discuss your health condition
  • Special programs for moms-to-be to stay healthy and to keep your baby healthy at no cost
  • Health classes and wellness tips at no cost
  • A large list of doctors and drugstores to choose from
  • Help you need in your own language. We offer no-cost interpretation services in many languages for members who do not speak English
  • No-cost programs for members with ongoing health concerns like heart disease, diabetes and asthma

Specialist care

Sometimes, you may need care from a specialist. You may need to see a specialist more than once. Your PCP will:

  • Tell you when you need to visit a specialist
  • Help you choose a specialist
  • Help you make an appointment
  • Give you an Authorization for referral services form. Take this form to your specialist. He or she will complete it and send it back to your PCP.

Make sure you tell your PCP and specialist as much as you can about your health. This will help them make sure you get the right care. You may also need prior authorization from us to get this care.

Prior authorization

We need to give prior authorization, or an OK, to get some types of care. This means that we agree that the type of care your PCP or specialist wants to give you is medically necessary. Medically necessary means this care will protect your life, keep you from getting seriously ill or disabled, or reduce your severe pain.

We need to give an OK before you get these types of care:

  • All elective and non-urgent inpatient care and admissions
  • Out-of-area or out-of-plan care, except in emergencies
  • Most surgeries, including some outpatient
  • Gastroenterology procedures, including upper endoscopy and procedures related to bariatric surgery
  • Inpatient and anesthesia care for dental procedures
  • Transplant services, except cornea. Members younger than 21 will be referred to California Children’s Services for transplant care
  • Rehabilitation therapy (respiratory and speech)
  • Some pain management tests and procedures
  • Most behavioral health and substance abuse care, including psychological tests
  • Advanced imaging (MRAs, MRIs, CT, CTA scans)
  • Some prescriptions
  • Home health care, including infusion services
  • Inpatient hospice care
  • Long-term services and supports
  • Some durable medical equipment, including prosthetics and orthotics
  • Experimental and investigational care
  • Transportation, except in an emergency
  • Digital hearing aids
  • Sleep studies
  • Some transgender procedures

You must get an OK from Vision Service Plan (VSP) for vision care at 1-800-877-7195 (TTY 1-800-428-4833).

We don’t need to give an OK if you get these types of care from a provider that is with our plan:

  • Chiropractic care for members residing in Sacramento
  • Dialysis
  • Emergencies
  • Well-woman checkups or obstetrical care
  • Standard X-rays and ultrasounds
  • Physical and Occupational therapy from a provider with our plan
  • Outpatient hospice care
  • Formulary glucometers and nebulizers

We don’t need to give an OK for family planning services. You can get these services from any provider.

You can find more information in our member handbook.

You can’t be billed by your doctor, hospital or any other provider. You have no copays for:

  • Covered services
  • Drugs prescribed by a doctor for the care and treatment of an injury
  • Drugs not listed on Anthem’s preferred drug list

If you have questions or want to learn more,
you can call us at 1-800-407-4627,
Monday through Friday, from 7 a.m. to 7 p.m.

If you have hearing or speech loss,
you may call our TTY line at 1-888-757-6034.

Pharmacy and Prescription Drugs

Anthem covers a wide range of prescriptions and over-the-counter medicines. You do not have a copay or deductible for prescription drugs.

We will cover your drugs if they are:

  • Ordered by a doctor
  • For the care and treatment of an injury or an illness
  • Approved by us when the drug is not on the Preferred Drug List (PDL)

You can use the links below to get more pharmacy information as well as the Preferred Drug List (PDL) for Medi-Cal and L.A. Care.

You can email and ask us for an exception at wrkgrp-submitmyexceptionreq@anthem.com.

Help for members affected by the Oroville Dam emergency in California

We’re taking steps to help our members affected by the Oroville Dam emergency. From February 13, 2017, through March 13, 2017, if you live in Butte, Sutter or Yuba County, or if you’re an emergency worker sent there to help, and you were affected, here’s what you should know:

  • If you’re part of an Anthem Blue Cross prescription drug plan, you can refill lost or damaged prescriptions at any drugstore
  • If you use a mail-order pharmacy, you can change your address by calling Member Services at the number listed on your member ID card
  • There will be no late penalties for late preapproval, precertification or referral requests
  • If your durable medical equipment (DME) was lost or damaged, you can get it replaced
  • You and your doctors will be given more time to file claims if needed

The exceptions above don’t apply to Medicare Advantage, Medicare Part D or Federal Employees Health Benefits Program members. These programs have other guidelines.

Questions? Call Member Services at the number listed on your member ID card.

We hope you and your loved ones stay safe.