Next Steps for New Members
Now that you have CenCal Health, who are we? CenCal Health is the health insurance plan for those who have Medi-Cal in Santa Barbara and San Luis Obispo counties. The local Department of Social Services determines your eligibility for Medi-Cal. Once you become eligible, you are automatically enrolled as a member of CenCal Health.
It is very important to schedule a new patient examination as soon as possible. CenCal Health encourages you to schedule within the first two (2) months of becoming a new member. If you need help with scheduling an appointment, you can call our Member Services Department at 1-877-814-1861. One of our Member Service Representatives will help you. Or, if you cannot hear or speak well, please call California Relay at 711 or TTY: 1-833-556-2560.
Below you will find some frequently asked questions and advice for those questions you may have.
What will happen next?
CenCal Health sends you a “new member packet” that includes your CenCal Health ID card and a handbook with information about how to use the health plan. Don’t throw the packet away! You may need to refer to it later.
When you first become eligible for Medi-Cal, the State of California will send you a Medi-Cal Benefits Identification Card (BIC). The new BIC has State of California written on top and has pictures of poppy flowers. If you have been on Medi-Cal before or are currently on Medi-Cal your current BIC, which is a white card with blue writing, is still valid and will not be reissued unless you lose your card. Your BIC will be used by doctors and providers to verify your Medi-Cal eligibility.
You may be asked to show both your CenCal Health ID card and your BIC card when you go to medical appointments, so always carry them with you.
What is a PCP and how do I find a doctor?
This is your main doctor who oversees your care and refers you to the other services you need. Your “new member packet” contains a Provider Directory, a list of doctors on our health plan, and a form for selecting a doctor.
If you already see a doctor, let us know who it is. If you don’t have a doctor, you need to pick one or you will be assigned to one. If you need help selecting a doctor, or if you ever want to change your PCP, you can call our Member Services Department.
What if I do not like my PCP or doctor?
It is important to have a good relationship with your PCP. Good health care needs a team effort between you and your doctor. If you would like to change to another PCP, call our Member Services Department and ask for help to change to a new PCP. You can request to change your PCP at any time. This change will be effective the first of the following month.
As a new CenCal Health member, what information will I be receiving?
You will be receiving a “New Member Packet” and it will have:
- CenCal Health Plan identification card;
- Member Handbook (which explains the program, services, and benefits);
- Provider Directory (list of doctors and specialist);
- Form to pick a Primary Care Provider and return envelope;
- Other information about health education and immunizations
- Privacy Notice;
- Language Card
What if I need to see a specialist?
When you need to see a specialist or get specialty services, your Primary Care Provider (PCP) will refer you to the specialist. If you think you should see a specialist and your PCP does not agree that you need a referral, you should discuss this with them.
If you are still not satisfied after talking with your doctor, you can call a Member Services Representative to talk about your concerns and file a complaint and/or change to a new PCP
What about medications?
Medi-Cal Rx is responsible for approving your medications. You will need a prescription from your doctor. Your doctor has a list of the medicines that are covered by the Medi-Cal Rx on the Contracted Drug List (CDL). For questions regarding your medication approvals, please call Medi-Cal Rx customer service at 1-800-977-2273. If you have Medicare, your medications are covered through your Part D program.
What can CenCal Health - Member Services do for me?
Member Services has staff who speaks English and Spanish who can help you with the following:
- Select or change your Primary Care Provider (PCP).
- Answer your questions about how to use CenCal Health.
- Arrange for interpreter services or transportation for your medical appointment.
- Get help if you receive a bill for covered services.
- Find a pharmacy or help you get your medicine or medical supplies.
- Solve a problem or take a complaint.
Please call Monday-Friday, 8am-5pm at our Member Service Department’s toll-free number 1 (877) 814-1861 if you have any questions or need assistance. You can also find information on our Members page. For hearing impaired members, please call the California Relay at 711.
What if I need Emergency or Urgent Care?
Emergency services are covered any time you are inside or outside of Santa Barbara or San Luis Obispo Counties. If you believe you or your child need medical care immediately, go to the nearest emergency room or call 911. If you need urgent care after hours, nights or weekends and you feel treatment should not wait until your Primary Care Provider’s office is open, urgent care services are available. You can find them in the attached After-Hours Brochure.