«Partnership HealthPlan of California Medi-Cal Member Handbook Together for your Health Our Service Area Del Norte, Humboldt, Lake, Lassen, Marin, ...»
I Indian Health Center is a type of Health Center that can provide you primary care and other types of health care. Native American Indian members are able to access services at an Indian Health Center (IHS) without Prior Approval from PHC. See Section 3 of this Handbook for more information.
Inpatient Hospitalization is when you are admitted to the hospital. Some hospital stays can be for one or more days. To learn more about inpatient hospitalization, see Section 5 of this Handbook for information.
M Medi-Cal is California’s Medicaid program. Medi-Cal is a joint federal and state health care program for people with low income or limited resources.
Medicare is the federal health care program for people who are 65 years of age or older, or who have certain medical conditions like End Stage Renal Disease (ESRD). To learn more about Medicare call (800) MEDICARE.
Member Services is a department at PHC that is responsible for helping you with your membership, benefits, grievances and more. You can call PHC’s Member Services Department at (800) 863-4155, 8am to 5pm, Monday through Friday.
N Network Pharmacy is a pharmacy that is contracted with PHC to provide covered prescription drugs to PHC members. You can find a list of pharmacies in your Home County Provider Directory.
Network Provider is a provider that has a contract with PHC to see PHC members. Not all contracted providers are open for new members. Call PHC’s Member Services Department if you need help finding a provider, or look in your Home County’s Provider Directory.
O Outpatient Hospital Care is when you receive care at a hospital that doesn’t involve you being admitted to the hospital. These can be specialty provider visits or even outpatient surgery. See Section 9 of this Handbook for more information.
P Primary Care Provider (PCP) is a provider that you choose, or is assigned to you to give you routine health care. Your PCP can prescribe medically necessary drugs and refer you to specialty providers. See Section 4 of this Handbook for more information.
Prior Approval is when your provider or PHC needs to review a request for health care services before you get them. We also call this “Prior Authorization”. See Section 9 of this Handbook for more information.
Provider Directory is a document that lists all of the providers that PHC contracts with. Each county in PHC’s service area has its own Provider Directory.
Q Quantity Limit is when only a certain amount of a prescription drug can be approved for reasons of quality, safety or utilization. Limits can be on the amount of drug that we cover per prescription, or for a stated period of time.
R Rural Health Center (RHC) is a type of Health Center that can provide you primary care and other types of health care. See Section 3 of this Handbook for more information.
S Service Area means the counties that are served by PHC. We list these counties in Section A of this Handbook.
State Hearing is when you want your complaint or appeal heard by an Administrative Law Judge (ALJ) that works for the State of California. See Section 12 of this Handbook for more information.
State Medi-Cal or “Regular Medi-Cal” is when you are receiving some or all services from any providers that are willing to bill the Medi-Cal program (not PHC). When members are enrolled in PHC, they will get most services from PHC’s providers.
Step Therapy is when PHC requires that you try one type of prescription drug before another prescription drug, prescribed by your provider, can be covered.
U Urgent Care is when you need care to treat a non-emergency medical illness, injury or condition that needs immediate medical care. See Section 7 of this Handbook for more information.