Below are some common questions and answers about CalOptima and Medi-Cal. If you do not see your question answered here, please call our Customer Service Department. We are here to help you and make sure you get access to the best health care possible.

You may change your PCP within the same health network for any reason every 30 days. Your health network's member services department can assist you in changing PCPs. The phone number for the member services department of your health network is on your CalOptima ID card.

Starting December 1, 2011, you and your eligible family members may ask to change health networks every 30 days. To do this you will need to complete a Health Network Selection Form. You may call CalOptima’s Customer Service Department to ask for a form. CalOptima must receive your form by the 10th of the month for your health network change to be effective the 1st of the following month. If you want to change your health network before December 1, 2011, please call CalOptima’s Customer Service Department to see if you are eligible to make a change.

If you have questions, please call CalOptima’s Customer Service Department at 1-714-246-8500 or toll free at 1-888-587-8088, Monday through Friday, from 8 a.m. to 5:30 p.m. We have staff who speak your language. TDD/TTY users can call 1-714-246-8523.

Ask your PCP for a referral. Your health network is responsible for authorizing referrals to specialists, for medical services and for medical supplies. The response time for routine prior authorizations is five working days and 24 hours for urgent prior authorizations.

You will be notified once a decision has been made. However, you may also call your health network to get the status of your authorization request.

Call the provider who gave the health care service you were billed for. Give the provider your CalOptima (Medi-Cal) and/or other insurance information. If you get another bill or are in collections, contact CalOptima’s Customer Service Department for help.

To reach CalOptima's Customer Service Department, call 1-714-246-8500 or toll-free at 1-888-587-8088, Monday through Friday from 8 a.m. to 5:30 p.m. We have staff who speak your language. TDD/TTY users can call 1-714-246-8523.

Your other health insurance is the primary payer and is responsible for covering the services you received. CalOptima (Medi-Cal) is the last payer. You will need to ask for payment for services through your primary insurance before CalOptima (Medi-Cal) will pay.

After-hours care is when you need medical attention after your PCP’s office is closed. If you need after-hours care:

If you are outside of Orange County and have an emergency or need urgent care:

The BIC is a card issued by the County of Orange Social Services Agency. This card is used to obtain Medi-Cal covered services.

The CalOptima ID card is issued by CalOptima. This card helps to identify you as a CalOptima member. It also tells you in which health network you are enrolled. It is important to have all health insurance cards with you and present them to your provider when you access health care services.

If you lose your BIC, call or visit your local County of Orange Social Services Agency. Click here for a list of offices.

If you lose your CalOptima ID card, call or visit CalOptima. You can reach CalOptima's Customer Service Department at 1-714-246-8500 or toll-free at 1-888-587-8088, Monday through Friday from 8 a.m. to 5:30 p.m. We have staff who speak your language. TDD/TTY users can call 1-714-246-8523.

Psychiatry and psychology services are covered through county mental health programs. Members can access benefits through Orange County Mental Health Plan by calling toll-free 1-800-723-8641.

CalOptima has a list of medications that are covered (paid for) by CalOptima. This list is called the Approved Drug List or Drug Formulary. CalOptima pays for medications on this list when they are filled at one of CalOptima’s network pharmacies. CalOptima’s Pharmacy Directory included in all new member packets.

If your doctor writes a prescription for a medication that is not on CalOptima’s Approved Drug List, your doctor or pharmacy must ask for approval. The approval request form is called a Prior Authorization (PA) form. All CalOptima network pharmacies have this form. Your pharmacy sends the form to your doctor. Your doctor completes the form and sends it back to the pharmacy to submit
to CalOptima.

In California, you can go to any participating chain pharmacy. Prescriptions filled outside of California need prior approval from CalOptima. Chain pharmacies are listed in the CalOptima Pharmacy Directory.

If you need help, please call CalOptima’s Customer Service Department at 1-714-246-8500 or toll-free at 1-888-587-8088, Monday through Friday from 8 a.m. to 5:30 p.m. We have staff who speak your language. TDD/TTY users can call 1-714-246-8523.

Denti-Cal provides dental care for members under the age of 21, an adult living in a nursing home or in an Intermediate Care Facility for the Developmentally Disabled (ICF-DD Habilitation and ICF-DD Nursing). To contact Denti-Cal, call toll-free at
1-800-322-6384.

Vision care services are provided to eligible CalOptima members through Vision Service Plan (VSP). To find out if you are eligible, please call CalOptima’s Customer Service Department, 1-714-246-8500 or toll-free at 1-888-587-8088, Monday through Friday from 8 a.m. to 5:30 p.m. We have staff who speak your language. TDD/TTY users can call 1-714-246-8523.

We need your correct name, address and phone number to contact you about your health care.

If you have a new name, address or phone number, you will need to report it
by calling:

If you have questions, call CalOptima's Customer Service Department.

You can speak with your CalOptima health care providers in the language of your choice. Many of our providers and staff speak your language. Our over-the-phone interpreter service is available to you 24 hours a day.

You can also ask for a face-to-face interpreter for your health care services. You do not have to ask family members or friends to interpret for you. For example, you can ask for an interpreter to be with you at your doctor visit if your doctor or the office staff does not speak your language. You need to ask for an interpreter at least five working days before your doctor’s appointment or at the same time you make your doctor’s appointment.

If you feel your language needs are not being met, you can file a complaint with CalOptima. For help with interpreter services, please call CalOptima’s Customer Service Department at 1-714-246-8500 or toll-free at 1-888-587-8088, Monday through Friday from 8 a.m. to 5:30 p.m. We have staff who speak your language. TDD/TTY users can call 1-714-246-8523.