Members - Frequently Asked Questions
- How do I call the Member Solutions Department?
- Can my child enroll in a different health network than me?
- If my child is not with CHA, can I enroll my child with CHA?
- When is CalOptima's annual Open Enrollment period?
- How will I know when the Open Enrollment period is coming?
- What do I do if I lost my child's id card?
- My child is assigned to a Primary Care Physician (PCP) I did not choose.
Can I change his/her PCP?
- What do I do if my child needs to see a specialist or needs special
medical services?
- What do I do if I get billed for health care services?
- What if my child has other health insurance?
- What if my child needs care when he/she is outside of Orange County?
- What if I need care after hours?
- Who do I call for dental care?
- Where do I call for mental health services?
- What type of transportation is available?
- Can I talk to the doctor in my own language?
- Who do I report my change of address or name to?
1. How do I call the Member Solutions Department?
You can call us toll free at 1-800-424-CHOC (2462). You can also reach us by using
the Contact Us page.
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2. Can my child enroll in a different health network
than me?
Yes, CalOptima members can now choose different health networks for different family
members. This means your children up to age 21 can continue getting their health
care services through CHA and you can be in another health network.
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3. If my child is not with CHA, can I enroll my child
with CHA?
Yes, your child can enroll with CHA during the first three (3) months of becoming
a CalOptima member or during CalOptima's annual Open Enrollment period.
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4. When is CalOptima's annual Open Enrollment period?
CalOptima's annual Open Enrollment period is from September 15 to December 15.
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5. How will I know when the Open Enrollment period is
coming?
Each year, CalOptima will mail a letter reminding members that the Open Enrollment
period is coming.
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6. What do I do if I lost my child's id card?
For the Medi-Cal Beneficiary Identification Card (BIC), call your local County of
Orange Social Services Agency.
For the CalOptima card, call the CalOptima Customer Service Department toll free
at 1-888-587-8088.
For the Healthy Families/CalOptima Kids card, call the CalOptima Kids Member Services
Department toll free at 1-800-530-2899.
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7. My child is assigned to a Primary Care Physician (PCP)
I did not choose. Can I change his/her PCP?
If you did not choose a PCP on the CalOptima Selection Form, CHOC Health Alliance
will assign your child a PCP close to your home. You may change your child's PCP
every 30 days. To do so, call our Member Solutions Department.
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8. What do I do if my child needs to see a specialist
or needs special medical services?
You can ask your PCP for a referral. Your PCP will work with CHOC Health Alliance
to get an approval.
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9. What do I do if I get billed for health care services?
You should first call the provider who is billing you. This should be the same provider
who provided care to your child. You should give this provider your child's CHOC
Health Alliance Medi-Cal information. You should then call CHOC Health Alliance
for further assistance or use the Contact Us page located
on our website.
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10. What if my child has other health insurance?
The other health insurance will be the primary payer responsible for covering the
services your child needs and/or received. CHOC Health Alliance will be the last
payer. You will need to seek payment for services through your child's primary insurance
before CHOC Health Alliance will pay.
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11. What if my child needs care when he/she is outside
of Orange County?
If your child is outside of Orange County and has an emergency situation, go to
the nearest hospital emergency room. Show the hospital staff your child's CalOptima
and/or BIC card and identify your child as a CHOC Health Alliance member. Ask the
hospital staff to call CHOC Health Alliance within 24 hours. If you are not sure
if it is an emergency, call your child's PCP. Do not use the emergency room for
routine care.
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12. What if I need care after hours?
If you have an emergency situation, go to the nearest emergency room or call 9-1-1.
Urgent care is medical care needed for sudden illness or injury that cannot wait
for a regular office visit. If your child has an urgent situation, call your child's
PCP first. If you cannot reach the PCP, call CHOC Health Alliance.
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13. Who do I call for dental care?
As a Medi-Cal member, your child can go to any dentist who takes Medi-Cal. You can
call Denti-Cal toll free at 1-800-322-6384 for a list of dentists.
For Healthy Families members, call CalOptima Kids at 1-800-530-2899 to find out
your dental plan.
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14. Where do I call for mental health services?
As a Medi-Cal member, your child can get most mental health benefits through CalOptima
Mental Health Plan. To get these services, call toll-free 1-800-723-8641.
For Healthy Families members, you may self-refer to a participating behavioral health
provider of your choice for an initial face-to-face assessment.
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15. What type of transportation is available?
Emergency transportation is available to CHOC Health Alliance members when the member's
medical conditions are life threatening. Non-emergency transportation will require
approval in advance from CHOC Health Alliance. You should call your PCP to schedule
transportation service.
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16. Can I talk to the doctor in my own language?
Yes. As a CHOC Health Alliance member, you can get free interpreter services when
you have a doctor's appointment. You can also ask to have an interpreter assist
you when you call CHOC Health Alliance. This includes sign language interpreters.
Call our Member Solutions Department toll free at 1-800-424-2462 for more information.
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17. Who do I report my change of address or name to?
Call the County of Orange Social Services Agency and/or the U.S. Social Security
Administration to report any changes such as name, telephone number and/or address.
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