My Health
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What Is Quality Improvement?
Did you know we check the quality of services that members like you receive? We call
this
Quality Improvement
. If you would like to know how we use that information to help
improve the quality of our benefts and services, or if you just want to learn more about
the program, visit
anthem.com/ca
. Under
Other Anthem Websites
, click
State Sponsored
.
Choose
Medi-Cal
. Then choose
Quality Improvement Program Overview: Medi-Cal and L.A.
Care
. You also can call
1-888-285-7801
for a paper copy.
At home with your PCP
When you frst become a member, get to know your PCP. Tis is the main doctor
you see for care. It can be a pediatrician, family doctor, general practitioner,
internist, obstetrician/gynecologist or even someone at a clinic. Tink of this
doctor and his or her ofce like a second home – your home for medical care.
It’s
important that you treat your PCP like your personal doctor
. You can see the
PCP for care or a well visit.
So why see your PCP? Here are three good reasons:
1
It’s a one-stop shop
: instead of having to fgure out where you need to go for a
problem, start with your PCP and you may only have to make one stop.
2
You get to know and trust a provider
: when you fnd a place or even a doctor
you like and see him or her regularly, you build trust. Tat can lead to both you
and your doctor being honest and working together to get you the best care.
3
You get personalized care
: if you have an allergy, does your doctor know it?
Does he or she know if you have a family history of disease? Te more the doctor
knows, the better-informed the doctor will be in order to make the decisions that
are best for you and cover your basic needs.
Remember, if you see a doctor who is not your PCP without an OK from us, the visit
may not be covered. It all depends on what you see the doctor for. Tis is explained in
your Member Handbook. So be sure to read it or call us if you have a question.
Also, you can change your PCP at any time for any reason. See your PCP before you
go to another doctor. It’s the best way to get the care you need.
Anytime, day or night, you can fnd information on our website.
Just log on to
anthem.com/ca
. You can learn:
•
•
About your benefts for different services. These could
include primary and specialty care, behavioral health and
hospital services.
•
•
How to see your PCP and get care.
•
•
How to learn about providers in your area.
•
•
What to do when you are out of the plan’s service area.
•
•
How to get information about accessing emergency care
and 911 services.
•
•
How to access care after normal offce hours.
•
•
How to fle a claim for covered services.
•
•
How to voice a complaint or appeal a decision. This includes
your right to an independent external appeal.
•
•
About your rights and responsibilities as a member.
•
•
About our Quality Improvement (QI) programs. You can see
how we use this information to review and help improve the
quality of our benefts and services.
•
•
How to ask for Advance Directives (Living Wills).
•
•
Information you can ask for and get every year, including a
new provider directory.
Need information specifc to your policy?
Register on the member website to:
•
•
Learn about your copays and the costs you will have to
share (if any).
•
•
View existing claims.
•
•
Change your PCP (if it applies to your health plan).
•
•
Order a new member ID card.
•
•
Get other specifc information.
Or you can refer to your Member Handbook to fnd
information about the benefts and services covered under
your plan. Your handbook also has any benefts that are
not covered or are limited. These include benefts that
may not be covered if you get services outside your plan’s
service area.
If you need a copy of the information on the web or in your
Member Handbook, call us at the number on your member ID card.
How to get a paper copy of notices
If you have any questions, or if you would like a current paper copy of the notices or updates
in this newsletter or a new Member Handbook, call
1-888-285-7801
. If you have hearing or
speech loss, call the TTY line at
1-888-757-6034
.
Ever heard of pharyngitis?
Pharyngitis is actually just the medical term for a sore throat. You might hear your doctor
use it when you have a cold or strep throat.
Pharyngitis is usually easy to treat. Many cases are caused by a virus, not bacteria.
In order to treat it, your PCP needs to know what type you have.
You should call
the PCP if you think you or a family member may have it
. The PCP will want to
run a simple strep test to see if it comes from bacteria. If it does, he or she may
prescribe antibiotics.
Sometimes pharyngitis can become dangerous. Call 911 or a doctor immediately if you also have:
Just a click away
•
•
Severe and prolonged sore throat.
•
•
Diffculty breathing.
•
•
Diffculty swallowing.
•
•
Diffculty opening your mouth.
•
•
Joint pain.
•
•
Earache.
•
•
Rash.
•
•
Fever (over 101 degrees).
•
•
Blood in saliva or phlegm.
•
•
Frequently recurring sore throat.
•
•
Lump in neck.
•
•
Hoarseness lasting over two weeks.
Sources: American Academy of Otolaryngology – Head and Neck Surgery website: entnet.org; American Medical
Association website: ama-assn.org