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PARTNERSHIP HEALTHPLAN OF CALIFORNIA

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What Is Partnership HealthPlan of California (PHC)?

PHC is a managed health care program for people on Medi-Cal.

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What is a Managed Health Care Program?

It is a health care program that makes sure all members have access to health care and can choose a primary care provider (PCP). All members (except in special cases) are assigned to a PCP. Members must go to their assigned PCP first for all of their primary care needs. If the PCP decides that specialty care is needed, he/she will refer the member for that care.

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What is Primary Care?

Primary care is basic medical services to help people stay healthy.

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What is a Primary Care Provider (PCP)?

He/she is your personal provider who will provide your medical care and refer you for specialty care if needed. All members (except in special cases) are assigned to a PCP.

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Selecting Your Primary Care Provider (PCP)

  • There are two ways to tell Partnership HealthPlan of California (PHC) which medical provider you want to be assigned to.

    Option 1:
    As a new PHC member you will receive a "New Member Packet". This packet will include a list of PCPs for you to choose from. We will also include a selection form that you can use to tell PHC which PCP that you would like to be assigned to. You can return this form to PHC or you may call our Member Services Department at (800) 863-4155.

    Option 2:
    You can complete your selection form at your current PCP's office and ask your current PCP can fax it to PHC.
  • If you have additional questions or specific concerns about the enrollment process, please contact PHCs Member Services Department at:

    (800) 863-4155

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Will my Medi-Cal Benefits Change When I Become a Member of PHC?

You will not lose any medical benefits. PHC offers services and benefits above the basic Medi-Cal Program.

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Will This Affect my Monthly Welfare or Social Security Check?

No. PHC provides only your medical care.

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Can I Keep the Same Doctor That I am Seeing Now?

If your doctor has joined PHC, you may be able to keep your doctor. Call your doctor to find out if your doctor is contracted with PHC.

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PHC MEMBER SERVICES DEPARTMENT

PHC has a Member Services Department that is available Monday - Friday, 8:00 am - 5:00 pm. You can call us at (707) 863-4120 or (800) 863-4155. The Member Services Representatives are there to answer your questions about PHC and help you with any problems you may have related to your medical care.

You should call the Member Services Department if you:

  • Want to transfer to a new primary care provider.
  • Are getting a bill for medical care.
  • Need a new PHC ID card
  • Would like to file an appeal or complaint about PHC, your medical care, or your medical provider.
  • Have any questions about PHC or the services PHC provides.
  • Have a problem getting a medical appointment.
  • Have a problem getting a prescription filled.
  • Have paid for medication and/or a co-pay.

Multi-lingual services and services for hearing, speech and visually impaired members are available through the PHC Member Services Department. For more information about these services, call our Member Services Department or refer to the appropriately titled sections of this website for additional information.

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HELPING MEMBERS COORDINATE THEIR MEDICAL CARE

So that we may assist you in coordinating your care, please call our Member Services Department as soon as possible if you are:

  • Receiving dialysis treatment
  • In a long term care facility
  • Restricted to a wheelchair or are bedridden
  • Enrolled in a hospice program
  • Enrolled in California Children’s Services (CCS)
  • Regional Center client
  • Diagnosed with AIDS
  • Pregnant
  • A organ transplant patient
  • Blind or hearing impaired
  • Scheduled for surgery, major diagnostic tests or procedure
  • Receiving medical care in Oregon or Nevada

Our Member Services Department is available to assist you Monday – Friday. 8:00am - 5:00pm at (800) 863-4155.

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ADDITIONAL SERVICES AND BENEFITS OFFERED BY PHC

Benefits

Clinical Support

Provider & Member Support

  • Pulmonary Rehab
  • Podiatry (for diabetics)
  • AODS Supplemental Services
  • Nutrition Counseling
  • Weight Management
  • Over-the-counter drugs
  • Transportation
  • Care Coordination
  • Care Transitions
  • Complex Case Management
  • Growing Together Perinatal Program
  • 24/7 Advice Nurse Program
  • Newsletter
  • Member Services Department
  • Local Provider Relations Staff
  • Claims Customer Service
  • Quality Improvement Program
  • Committee Structure
  • Local Governance

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CALIFORNIA CHILDREN'S SERVICES (CCS)

California Children’s Services (CCS)
California Children’s Services (CCS) is a state program for children with certain health problems and physical limitations. Through this program, children under 21 years old can get the health care and services they need. CCS and PHC will work together to connect you with providers and trained health care providers who know how to care for your child with special health care needs.

Common questions:

  • Who is eligible?

  • Children under 21 years old;
    Children that have or may have a medical problem that CCS covers;
    Children that are residents of California; and
    Meet income requirements.

    • What does CCS do?

    • CCS will help manage your child’s health care. Sometimes CCS will refer your child to other agencies, like public health nursing and regional centers. CCS also has a Medical Therapy Program (MTP). MTP’s are usually in public schools and provide physical and occupational therapy to eligible children.
      • Can my child use any provider?

      • No. CCS must approve the medical provider.

      For more information about the CCS program, contact your county CCS office. You can find their address and phone number in the government section of your phone book. Look under California Children’s Services or County Health Department. You may also look for your CCS local office at: http://www.dhcs.ca.gov/services/ccs/Pages/CountyOffices.aspx.

      If your child is currently enrolled in CCS and you need assistance or are having a problem getting care, please contact our Care Coordination Department at (800) 809-1350.

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      Coordination of Care

      In an effort to provide continuity of care during this transition we offer a team of nurses and health care guides to assist you. Please call our Care Coordination Department at (707) 863-4276 if you are:

      • Pregnant (PHC offers incentives for early entry into care and timely postpartum checkups)
      • Medically complex with multiple chronic illnesses
      • Challenged by navigating the health care system
      • In need of resource assistance

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