We have compiled a list of our most frequently asked questions. Detailed information on these subjects can be found in the Member Handbook/Evidence of Coverage on the page number noted after the question. If you did not receive a copy of the Member Handbook, or Provider Directory, please call a Member Services Representative at 1-877-814-1861, to request one.

What is the Benefits Identification Card (BIC)?
What is the Health Initiative Identification Card?
Can I see a doctor before I receive my cards?
What if I have other insurance?
Do I need to pay for my services?
How often can I see the doctor?
Can I get a list of doctors?
What if I don't like the PCP I'm assigned to? Can I change doctors?
What if I need to see a specialist?
When do I need a referral?
How do I get services when I am outside the County?
What medications are covered?
What pharmacy can I use?

When you first become eligible for Medi-Cal, you will receive a Medi-Cal Benefits Identification Card (BIC) in the mail from the State a white plastic card.This card is used to verify your eligibility for Medi-Cal and Medi-Cal covered services and should be carried with you at all times.

When you become a health plan member, you will receive a gray Health Initiative Identification Card in the mail. This card will have the name and phone number of your Primary Care Provider on it. The back of this card will also have important information regarding emergency care, non emergency care, and where doctors can call for authorization and to verify your eligibility for Medi-Cal.

Please carry both your Medi-Cal Benefits Identification Card and your gray Health Initiative Identification Card with you at all times and show them when you need medical care.When a doctor, hospital worker, or other medical provider asks about your insurance coverage, tell them that you have Medi-Cal and that you are a member of the Santa Barbara Regional Health Authority.Always show both your cards. If you have other health insurance, also present that information.

Back to top

To receive Medi-Cal you must apply through the Department of Social Services, or be receiving Supplemental Security Income (SSI) through the Social Security Administration.Once you have been determined eligible for Medi-Cal, you will be issued a Benefit Identification Card (BIC) and Health Initiative Card within 7 to 10 days. Since medical providers have no way to know if you are eligible for Medi-Cal benefits without the BIC, you will have trouble accessing care except in a medical emergency.Therefore, if you need medical care before receiving your identification cards, contact your Eligibility Worker or the SSI clerk at the Department of Social Services to request an "immediate need Medi-Cal card".

If you have other health insurance in addition to Medi-Cal, you must use your other insurance first. Your other insurance, for example, Medicare or Blue Cross, will be your primary insurance and Medi-Cal will be your secondary insurance.Your primary insurance will always be billed first before Medi-Cal.

You should present all insurance information, your Benefits Identification Card, and your Health Initiative Identification Card when seeking medical care.If you are established or assigned to a doctor under your other insurance plan, ask the doctor if he accepts Medi-Cal and if he is willing to be your Primary Care Provider. If the doctor agrees, you can select him as your Primary Care Provider under your insurance and Health Initiative.

Back to top

As a Medi-Cal recipient, you should not ever be billed for services except for co-payments or if you are a share of cost member.

Co-Payments Under the Medi-Cal program, providers are allowed to charge the member a reasonable amount to provide certain medical services.This amount is known as a co-payment.A provider may not refuse to treat you if you do not have the money for a co-payment, however they can bill you.The following is a list of approved co-payments:

• $5.00 for non-emergency services provided in an emergency room.
• $1.00 for outpatient services, such as doctor, optometry, and chiropractic visits.
• $1.00 for drug prescriptions (each drug prescription or refill).

The following members do not need to make co-payments:

• Children under 18 years of age.
• Members in the hospital or in a facility providing long-term care.
• Women during pregnancy and 60 days after delivery.
• Children in AFDC foster care.
• Hospice patients.
• Members' seeking family planning services and supplies.

There are situations that may cause you to receive a bill that you want to avoid. Listed below are situations in which you can be billed:

• If you ask for and receive services that are not covered by Medi-Cal.
• If you do not tell a provider that you have Medi-Cal.
• If you go to a provider that tells you they do not take Medi-Cal or will not accept your Medi-Cal, but you tell the provider you want to be seen there anyway and that you will pay for the services yourself.
• If you have other insurance and Medi-Cal, and you do not follow the rules for how to get services under your insurance.

If you are asked to pay for services, except for the situations listed above, please ask the provider to call the health plan so we can explain to them how to bill us.If you get a bill from a provider, please call a Member Services Representative for assistance in resolving your billing concern.

How often can I see the doctor?

There is no limit to the number of times that you can see your doctor. We encourage you to see your Primary Care Provider for preventive checkups and when it is medically necessary.

Back to top

Each Health Initiative member is mailed a Provider Directory when becoming an eligible plan member.We also mailed all of our existing members a Provider Directory in October 2000. This Directory is a list of health care providers who are available to you as a member of the health plan, which includes Primary Care Providers and referral and allied providers.

It is important to establish a good relationship with your PCP.Your health care requires a team effort between you, your PCP, and your PCP's staff.If you are not able to establish a good doctor/patient relationship with your doctor, call a Member Services Representative to request a change of PCP. See the Member Handbook/Evidence of Coverage for ways you can make your visit to your doctor more useful.

When you need to see a specialist or get special services, please ask your Primary Care Provider (PCP) for a referral.If your PCP agrees, he or she can refer you to a specialist.When you ask your PCP for a referral, it is important to be very clear about why you want the referral and to give your PCP any information on your medical history that he or she should know. If your PCP does not agree that you need a referral, you can call a Member Services Representative to talk about your concerns. The Representative will help you get the care you need.

You need a referral to see a specialist, obtain lab tests, x-raysor to have surgery. A referral is permission that comes from your PCP and does not have to be approved by the health plan.

Back to top

If you are outside of the health plan's service area (Santa Barbara County) and get sick, please call your PCP unless it is an emergency.If it is an emergency, go to the nearest emergency room or call 911.If the hospital determines that it is not an emergency, ask them to call your PCP.Show your Benefits Identification card and your Health Initiative Identification Card.Your PCP must authorize any medical care that is not an emergency.

One of your benefits as a health plan member is being able to get medications you need as part of your medical care.You will need a prescription for any medication. Each health plan doctor has a list of the drugs and medications that are covered by the health plan. This list is called a formulary. Call a Member Services Representative if you would like a copy of the formulary mailed to you.

The Provider Directory has a list of all the health plan pharmacies that you can use to fill your prescriptions. Prior to having a prescription filled, tell the pharmacy staff that you are a member of the Health Initiative program and present both your Benefits Identification Card and your Health Initiative Identification Card.

Back to top

If you have other questions regarding the Health Initiative program, please refer to your Member Handbook/Evidence of Coverage or call a Member Services Representative 1-877-814-1861.

©2007 CenCal Health 1.800.421.2560 • 1.805.685.9525     HOME | FOR MEMBERS | PARA MIEMBROS | FOR PROVIDERS | ABOUT CENCAL HEALTH | CONTACT US