How to See a Doctor
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Community Advantage Plus (HMO D-SNP)
As a Community Advantage Plus member, you have choices when it comes to your care. You may continue seeing your current doctor or clinic if they are part of the Community Advantage Plus Medicare and Medi-Cal network. If you prefer, you can select a new provider from the Provider Directory, which lists all contracted primary care physicians (PCPs), specialists, medical groups, and hospitals, along with helpful details about each one.
If you would like to use a specific specialist or hospital, be sure your PCP belongs to the same medical group that works with that specialist or facility. Your membership card includes the name and phone number of your PCP for easy reference.
You also have the option to change your PCP at any time. Simply call Member Services for assistance in selecting or switching your PCP.
Member Services
Call our Member Services representatives at 1-888-484-1412 (TTY: 711).
How do you get care from your PCP?
To schedule a visit with your PCP, call the office directly using the phone number printed on your membership card. Your PCP is your main partner in preventive care, and we recommend you schedule a wellness visit at least once a year—not only when you are sick.
How do you get care from specialists and hospitals?
If your PCP determines you need specialized care, they will provide a referral (advance approval) so you can see a plan specialist. Specialists are doctors who focus on a particular health condition or area of the body.
In most cases, a referral is required before you can receive care from a specialist or at a hospital, except in situations such as:
- Emergencies
- Urgent care
- Visits to an OB/GYN
Without a referral, you may be responsible for the full cost of services.
See our Provider/Pharmacy Directory for the most current listing of Providers in our contracted Network. Contact the Member Services staff at 1-888-484-1412 (TTY: 711), our Member Services staff is available to assist you 24 hours a day, 7 days a week.
The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year. We will send you a notice before we make a change that affects you.
Out-Of-Network Medical Coverage
In most cases, your benefits only cover care provided by doctors, clinics, and hospitals in the Community Advantage Plus network. Exceptions include:
- Emergency or urgent care when a network provider isn’t available
- Dialysis services outside the service area
- Care from an out-of-network provider when authorized in advance
If you receive services from providers outside the network without authorization, you may be responsible for the full cost of care. For more details, please review your Member Handbook.
Disclaimers
Community Advantage Plus (HMO D-SNP) is an HMO D-SNP health plan with a Medicare contract and a contract with the Medi-Cal program. Enrollment in Community Advantage Plus depends on contract renewal.
ATTENTION: If you speak another language, language assistance services, free of charge, are available to you. Call 1-888-484-1412 (TTY: 711), 24 hours a day, 7 days a week. The call is free.
ATENCIÓN: Si habla español, hay servicios de asistencia de idiomas disponibles sin cargo. Llame al 1-888-484-1412 (TTY: 711). Las llamadas a estos números son gratuitas.