Webinars - Questions Received and Answered

A primary care physician (PCP) is your main doctor. Always try to go to your PCP first for health concerns or questions.

 

Your PCP coordinates any other care you need, such as a visit to a specialist or a hospital stay. You may need to contact your PCP to get an OK (prior authorization) before you get certain services.

 

Most PCPs are family or general practitioners, internists or pediatricians. These types of doctors have gone to school to learn about all areas of health. That way, they can get a strong, overall picture of your health.

You may need to contact your Primary Care Physician (PCP) to get an OK (preapproval) before you get certain services. Your PCP will work with you to decide if you need to see a specialist. If so, your PCP will refer you to a specialist in your medical group.

 

Anthem

You can go to http://www.anthem.com/ca/cityofla and use our online Find a Doctor tool to find available physicians. If you already know the PCP you want, you can call our Member Services team at the number on your member ID card. Let us know who you want to choose as your new PCP and we’ll take it from there.

Kaiser

Kaiser Permanente members are not required to select a PCP before coverage starts and will not be automatically assigned a PCP. Kaiser members can receive urgent care or emergency care services without choosing a PCP. Kaiser members may elect to choose a PCP before MEDICAL COVERAGE & CASH-IN-LIEU or while making a regular doctor’s appointment.

If it is an emergency, call 9-1-1 or go to the nearest hospital - you don’t need an OK from us or your PCP. But be careful not to use the emergency room unless it really is an emergency.

 

Anthem

You can also log into www.anthem.com/ca/cityofla and use the Find a Doctor tool to look for an urgent care center. You can usually walk in without an appointment needed. And they can handle lots of urgent health issues like a flu or cold, allergies, prescribing medication, even small fractures and X-rays.

You can also use LiveHealth Online to access non-emergency after hours care. LiveHealth Online gives you 24/7 video visit access to board-certified physicians using a mobile device or a computer with a webcam. No appointment is necessary, and you pay your regular copayment. To learn more, go to livehealthonline.com or download the LiveHealth Online mobile app from the App Store® or Google PlayTM.

 

Kaiser

Visit a Kaiser Urgent Care facility, email your doctor, or talk to member services representative. Go to my.kp.org/ca/cityofla

Doctors, hospitals, facilities (such as labs) and other professionals who provide health care services may have a contract with Anthem. If they do, they're in the Anthem network - also called in-network providers. That means they accept Anthem payment rates when Anthem members go to them for care. If they don't have a contract with Anthem, they're outside of the Anthem network - or out of network providers.

When you see network providers, you only have to pay the copays, deductibles and coinsurance required by your plan. If you get treatment from a provider outside the network, you could have to pay much more. Check your benefit summary or Evidence of Coverage for details regarding how out-of-network services are covered.

 

Additionally, providers in the Anthem network are responsible for getting any needed precertification (approval) for your care. They also file your claim for you and will seek payment from Anthem for covered services.

 

Please log into www.anthem.com/ca/cityofla and use the Find a Doctor tool to determine if a particular provider is in the network,  contact Member Services at the number on your ID card, or talk with the Anthem Member Advocate at City Hall

Anthem

Before traveling, contact Anthem Blue Cross Customer Service at the number listed on your member ID card for a list of participating hospitals. Always go to the closest emergency facility; request an itemized bill (in English) before leaving to file a claim for reimbursement. The BlueCross Blue Shield Global Core Service Center is available 24 hours a day, seven days a week toll free at 800-815-BLUE or by calling collect at 804-673-1177. An assistant coordinator, along with a medical professional, will arrange doctor or hospitalization needs.

Kaiser

Go to the nearest emergency facility and call 800-225-8883 if you receive treatment. Request an itemized bill (in English) and save your receipt to file a claim for reimbursement.

Anthem

If you are covered through an HMO plan and your child is going to school outside of our service area, there may be special circumstances under which your child may be eligible for a guest membership in a medical group in the city your dependent lives in while away from home. Before you leave home, call the Member Services number on your ID card for assistance. Even without a guest membership, you can get medically necessary care (urgent care, emergency services, or follow-up care) when you are away from home.

If you are covered through the PPO plan, medically necessary care is covered for your child who is outside of our California service area through our national BlueCard network. Please visit www.anthem.com/ca/cityofla or call the Member Services number on your ID card to find a participating provider in the area your child is in.  

 

Kaiser

Go to any Kaiser facility for covered care. To find a Kaiser facility, visit kp.org or call 800-464-4000. If no Kaiser facility is available, only emergency care is covered.

The DCUSA HMO plan covers braces for adults and children, and the PPO plan covers braces for children to age 26 only. Coverage is as follows:

DCUSA DHMO plan -

Children under 19 - Member copayment is $1,000 plus start up fees of $300 Children 19-26 - Your copay is $1,350 plus start up fees of $300 Adults - Your copay is $1,350 plus start up fees of $300

Delta PPO plan -

Delta pays 50% of the cost up to $1500 per lifetime per child

The maximum is the amount of money that Delta Dental will pay toward services in a calendar year per person. Once Delta has paid $1500 in a calendar year, any other costs would become your responsibility. Please note that preventive services do not apply toward this maximum.

There are many situations. But in general:

  • To reinstate coverage after failure to make a required premium payment
  • To purchase Life insurance over $750,000, or to increase your current amount
  • To purchase Dependent Spouse Life insurance of any amount
  • To purchase supplemental Disability insurance

Accidental Death and Dismemberment (AD&D) insurance offers additional financial protection for an employee, or a family member, if they die in an accident, are dismembered, or lose their vision, hearing, or ability to speak.