• I just enrolled into the Blue Shield Promise Cal MediConnect Plan. How and when can I get care I need?

    You may begin using Blue Shield Promise Cal MediConnect Plan network primary care providers and pharmacies for all of your health care services and prescription drugs starting from the effective date of your enrollment. If you need emergency or urgently needed care, or out-of-area dialysis services, you can use providers outside of Blue Shield Promise Cal MediConnect Plan’s network.

    To help with the transition to Blue Shield Promise Cal MediConnect Plan, you may be able to keep seeing the doctors you used to see prior to joining Blue Shield Promise Cal MediConnect Plan for up to six (6) months for Medicare services and twelve (12) months for Medi-Cal services from the effective date of your enrollment. 

    You will also have access to a 30-day supply of prescription drugs you currently take during your first 90 days in the plan if you are taking a drug that is not on our List of Covered Drugs, if health plan rules do not let you get the amount ordered by your doctor, or if the drug requires prior approval by Blue Shield of California Promise Health Plan.

    Contact Blue Shield Promise Cal MediConnect Plan Member Services at (855) 905-3825 [TTY: 711], 8 a.m. – 8 p.m., seven days a week for information on how to do this.

  • How much do I have to pay for my medical care on Blue Shield Promise Cal MediConnect Plan?

    You don't have to pay a plan premium, deductible, or copays when getting health services through a Blue Shield Promise Cal MediConnect Plan provider.

  • Why do I need a primary care provider?
    You will get your routine or basic care from your primary care provider (PCP). Your PCP can also coordinate the rest of the covered services you need.
     
    Our plan’s PCPs are affiliated with particular medical groups. When you choose your PCP, you are also choosing the affiliated medical group. This means that your PCP will be referring you to specialists and services that are also affiliated with his or her medical group. So, if there is a particular Blue Shield Promise Cal MediConnect Plan specialist or hospital that you want to use, it is important to see whether they are affiliated with your PCP’s medical group.
     
    When you need specialty care or additional services your PCP cannot provide, he or she will give you a referral. In most cases, you must see your PCP to get a referral before you see any other health care providers or visit a specialist. Once this referral is approved by your PCP’s medical group, you can make an appointment with the specialist or other provider to get the treatment you need. The specialist will let your PCP know when you have completed your treatment or service, so your PCP can continue to manage your care.

    Also, your PCP may need to get approval in advance from the Plan for you to get certain services. This approval in advance is called “prior authorization.” For example, prior authorization is required for all non-emergency inpatient hospital stays. In some cases, your PCP’s affiliated medical group, instead of our plan, may be able to authorize the service.

    You can get certain services without first getting approval from your PCP, such as: 
    • Emergency services, 
    • Urgently needed care, 
    • Kidney dialysis services from a Medicare-certified dialysis facility, 
    • Flu shots, hepatitis B, and pneumonia vaccinations, 
    • Routine women’s health care and family planning services.

     

     

  • How can I choose a primary care provider or a specialist?

    You can find a guide on how to choose a doctor in the Blue Shield of California Promise Health Plan Provider Directory. The directory contains a list of doctors near you. If you have any questions or need help contact our Member Services at (855) 905-3825 [TTY: 711].

    You can also search for a doctor, primary care physician or a specialist using our online Find a Provider tool.

  • How do I get care after hours?

    It is important you always carry your Blue Shield Promise Cal MediConnect Plan ID card with you. Call your doctor if you need medical care and he or she can help you to arrange care. If your doctor is not available, contact Member Services at (855) 905-3825 [TTY: 711] and we will help you. If you think you have an emergency, call 911 or go to the nearest hospital emergency room.

    You may also connect with a registered nurse at any time for advice based on your current symptoms. The nurse can help you decide if you need to see the doctor, what to do if your symptoms get worse, and what you can start doing at home to feel better. It's free and easy!

    Phone: (800) 609-4166 [TTY: 711], 24 hours a day, 7 days a week.

     

  • What do I do if I lose my ID Card?

    If you lose your ID card, call Member Services at (855) 905-3825 [TTY: 711] to request a new card or submit a request online. If you are having trouble getting care because you lost your card, call Member Services and someone will be able to help you.

     

  • How much do I have to pay for prescription drugs?

    When you get your prescription drugs at our network pharmacy, your copay will vary from $0 to $8.95 per drug. Copays for prescription drugs may vary based on the level of Extra Help you receive. Please contact Blue Shield Promise Cal MediConnect Plan for more details.

     

  • How can I get interpreter services?

    Our Blue Shield Promise Cal MediConnect Plan Member Services has multilingual staff. They will be able to help you in your language when you call. If you need interpreter services for appointments, call (855) 905-3825 [TTY: 711] and arrange for these services.

    We also offer face-to-face interpreter services and sign-language services upon your request. For more information, see our non-discrimination notice and learn how to access materials and documents in various languages

  • What if I have other health or prescription drug coverage?

    If you have other health or drug coverage, such as from an employer or union, TRICARE, the Department of Veterans Affairs, or Medigap (Medicare Supplement Insurance), you or your dependents could lose your other health or drug coverage, and not get it back, when you join Blue Shield of California Promise Health Plan.

    Contact the benefits administrator of the other health/drug coverage if you have questions about your coverage. If you want to cancel your enrollment in Blue Shield Promise Cal MediConnect Plan, you must call Health Care Options at (844) 580-7272 / [TTY: (800) 430-7077], 8 a.m. to 6 p.m., Monday through Friday.

  • How do I file a complaint?

    Blue Shield of California Promise Health Plan wants to give you the best care and services. Sometimes you may not be satisfied with the services you have received. 

    You can contact Member Services at (855) 905-3825 [TTY: 711] with questions or to file a verbal complaint. You can also file a formal complaint in writing. Blue Shield of California Promise Health Plan will send you a written acknowledgement within five (5) days of your filing a complaint. Blue Shield of California Promise Health Plan will also send you a written decision within 30 days. You can also get a formal complaint form at your doctor's office or file a complaint online.

     

  • What if I have a complaint about the quality of care I receive, or think my coverage for a hospital, home health agency, skilled nursing or comprehensive outpatient rehabilitation facility, is ending too soon?

    If you have a complaint about quality of care and think that your coverage for your hospital, skilled nursing facility, home health agency, or comprehensive outpatient rehabilitation stay is ending too soon, you can file a complaint with the Quality Improvement Organization (in California, this is Livanta). Blue Shield of California Promise Health Plan members can file a complaint with Livanta:

    Livanta (California's Quality Improvement Organization) contact information:
      Phone: (877) 588-1123
      Fax: (833) 868-4063
      Website: www.livantaqio.com
      Livanta BFCC-QIO Program
    10820 Guilford Road, Suite 202
    Annapolis Junction, MD 20701

    Please visit the Appeals section of the website for more information. Details are also included in your Member Handbook

  • Can I leave Blue Shield Promise Cal MediConnect Plan after enrolling in it?

    Yes. You may leave Blue Shield Promise Cal MediConnect Plan or choose a new Cal MediConnect plan at any time during the year. To make the change, call Health Care Options at (844) 580-7272 [TTY: (800) 430-7077], 8 a.m. to 6 p.m., Monday through Friday.

    If you leave Blue Shield Promise Cal MediConnect Plan and don’t want to enroll in another Cal MediConnect plan, your coverage will end the last day of the month after you notify us. If you leave Blue Shield Promise Cal MediConnect Plan and don’t join a Medicare health or prescription drug plan, you’ll be covered under Original Medicare. Original Medicare will enroll you in a Medicare prescription drug plan.

  • What if I want to join a different Cal MediConnect plan?

    If you want to keep getting your Medicare and Medi-Cal benefits together from a single plan, you can join a different Cal MediConnect plan. To enroll in a different Cal MediConnect plan, call Health Care Options at (844) 580-7272 [TTY: (800) 430-7077], 8 a.m. to 6 p.m., Monday through Friday. Tell them you want to leave your current Cal MediConnect plan and join a different Cal MediConnect plan. If you are not sure what plan you want to join, they can tell you about other plans available in your area.

     

  • What happens to my Medicare if I leave Blue Shield Promise Cal MediConnect Plan?

    If you leave Blue Shield Promise Cal MediConnect Plan and don’t join a Medicare health or prescription drug plan, you’ll be covered under Original Medicare, and Medicare will enroll you in a Medicare prescription drug plan. 

    If you want to join another Medicare health or prescription drug plan, want to know more about Medicare plans in your area, or have questions about Medicare, contact Medicare at 1-800-MEDICARE (800) 633-4227 [TTY: (877) 486-2048], 24 hours a day, seven days a week, or visit medicare.gov.

  • What happens to my Medi-Cal if I leave Blue Shield Promise Cal MediConnect Plan?

    In order to keep your Medi-Cal services, including long-term services and supports (LTSS) that help you with ongoing personal care needs, you must have a Medi-Cal health plan. If you leave your Cal MediConnect plan, you will need to let Health Care Options know which Medi-Cal managed care plan you want to join. 

    To do so, call Health Care Options at (844) 580-7272, [TTY: (800) 430-7077], 8 a.m. to 6 p.m., Monday through Friday. Tell them you do not want to be enrolled in Blue Shield Promise Cal MediConnect Plan and you want to join a Medi-Cal managed care plan. If you are not sure about which plan you want to join, they can tell you about other plans available in your area.

  • How can I get help choosing a new plan after leaving Blue Shield Promise Cal MediConnect Plan, or if I want more information about different plans?
    • If you want to talk to a health insurance counselor about the plan changes you'd like to make and your choices, call the California Health Insurance Counseling and Advocacy Program (HICAP) at (800) 434-0222 [TTY: 711], 8 a.m. to 5 p.m., Monday through Friday.
    • If you need help enrolling in a Cal MediConnect or Medi-Cal plan, call Health Care Options at (844) 580-7272, [TTY: (800) 430-7077], 8 a.m. to 6 p.m., Monday through Friday.
    • If you are in a Cal MediConnect plan and need further help, call the Cal MediConnect Ombuds Program at (855) 501-3077, [TTY: (855) 847-7914], 9 a.m. to 5 p.m., Monday through Friday.