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UCLA Obstetrics and Gynecology

UCLA Obstetrics and Gynecology

UCLA Obstetrics and Gynecology
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UCLA Obstetrics and Gynecology

Insurance Information

Insurance Information

Insurance Information

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Insurance Information

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It’s important that we have all of your insurance information at the time of scheduling your appointment.  If you have a plan that requires authorization, please arrange for this before calling us. A copy of the authorization should be faxed to (310) 206-3649.  If you have more than one plan, we will need information for all of your plans.

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HMO

An HMO is a health maintenance organization.

  • An HMO is a kind of health insurance that has a list of providers, such as doctors, medical groups, hospitals, and labs. You must get all of your health care from the providers on this list. This list is called a network.
  • Usually you have a main doctor, who is part of a medical group that has a contract with the HMO. Your main doctor is your primary care doctor and manages your care. If you need to see specialists, get tests, or be in the hospital, your doctor and the medical group must approve the service.
  • To be seen at UCLA, please contact your main doctor or medical group to obtain authorization.  If your medical group is not contracted with UCLA, your medical group will also need to set up a one-time contract with our contracting department.

PPO and POS plans

PPO and POS plans are kinds of health plans. Like an HMO, these plans have provider networks, but you can choose to see doctors outside of the network and pay more.

PPO Plans
A PPO is a preferred provider organization. A PPO is good plan for people who want to see providers without prior approval from their health plan or medical group and who do not want to choose a primary care doctor.

  • You get most of your health care from a network of doctors and other providers.
  • You can choose to go outside of the network for some care and pay a higher cost.
  • You usually pay a yearly deductible before the PPO starts to pay some or all of your bills.
  • You usually pay a co-insurance, or percent of the bill, when you get a covered service. The PPO pays the rest.

POS Plans
A POS is a point of service plan. It is a mix between an HMO and a PPO.

  • You have a primary care doctor and you get most of your health care from an HMO network.
  • You can choose to use your PPO benefit, which will probably be at a higher cost to you.

UCLA is contracted with most major PPO plans, but if UCLA is not in network with your plan, you might not have coverage at all to come to UCLA.  Additionally, some PPO plans do not cover both a professional and a facility fee.

Family Pact

Family PACT is a family planning program that helps eligible Californians avoid getting pregnant or causing a pregnancy when they are not ready.
Family PACT is a limited-benefits family planning program with four simple eligibility criteria: 

  1. You must be a California resident;
  2. Your income for your family size must be at or below 200% of the federal poverty guidelines;
  3. You must have no other source of health care coverage that can be used for family planning services;
  4. You want to prevent an unplanned pregnancy.

Medi-Cal Managed Care

Medi-Cal is health care for people with low or no income. Some people who have Medi-Cal are in a Medi-Cal Managed Care plan. These plans have networks of providers, including doctors, pharmacies, clinics, labs, and hospitals. You must use the providers in your network when you need health care.  UCLA is usually not in your network, but you can still request authorization from your plan to get care here.

Your Primary Care Doctor
You will have one doctor or clinic that you go to first for most of your health care. The health plan may choose a doctor or clinic for you when you join the plan. You can change your doctor or clinic if you want. Call your plan and ask for a list of doctors and clinics.

Medi-Cal Benefits
Medi-Cal covers the basic benefits that all health plans cover. Medi-Cal also covers prescription drugs, vision care, and hearing care.

If You Have a Complaint

  • If you have a problem, you can contact your Medi-Cal Managed Care Plan and file a complaint.
  • For help with your complaint, you can call the Medi-Cal Managed Care Ombudsman at 1-888-452-8609. Call between 8 AM and 5 PM. Your call is free and help is offered in many languages.
  • If you are not satisfied with your plan’s response, you can ask for a Medi-Cal State Hearing—call 1-800-952-5253. This is a review of your problem by the state. (Note: If you start the Medi-Cal State Hearing process you cannot get an Independent Medical Review from the Help Center.)
  • You can also call the Help Center at 1-888-466-2219. They can help you file a complaint or ask for an Independent Medical Review.

Presumptive Eligibility Medi-Cal
Presumptive Eligibility (PE) for Pregnant Women is a Medi-Cal program designed to provide immediate, temporary coverage for prenatal care to low-income pregnant women pending a formal Medi-Cal application.

Any woman who thinks she is pregnant, is a California resident, and whose family income is under a certain amount is eligible for Presumptive Eligibility (PE) for Pregnant Women.  However, she must seek this care through a participating provider and they will determine if you are eligible for this program. 

PE is a temporary Medi-Cal program that does not cover labor and delivery, or inpatient care.  That is why it is important for PE patients to apply for Medi-Cal right away. PE Medi-Cal Program >

Medicare

Medicare is a national health insurance program for:

  • Most people 65 and older.
  • Some younger people with disabilities.
  • People with End-Stage Renal Disease (kidney failure requiring dialysis or a transplant).

Medicare Advantage is Medicare's managed care program. If you join Medicare Advantage, you get all your care through an HMO or PPO that has a contract with Medicare. The Federal Center for Medicare Services (CMS), not the California Department of Managed Health Care (DMHC), regulates Medicare Advantage plans. DMHC conducts initial licensure review and financial oversight on Medicare Advantage plans

Get Help from HICAP
HICAP is the Health Insurance Counseling and Advocacy Program. Anyone who has Medicare can get free help with forms, problems, and questions. Call HICAP at 1-800-434-0222 or visit the HICAP web site.

Related:

  • More health plan info on uclahealth.org >
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