Winning Health | Gold Coast Health Plan | Issue 3 | Winter 2018

Let your voice be heard! Gold Coast Health Plan (GCHP) wants to hear from you. There are different ways for you to let the Plan know how it is doing and how it can improve. One of those ways is through the Consumer Advisory Committee (CAC). The CAC is made up of GCHP members and people who work in agencies and programs that provide services to the Plan’s members. The CAC allows the Plan to hear from its members and those who serve them. The Plan uses this information to better understand what members want and need. Any GCHP member or parent/ guardian of a child who is a GCHP member can apply to join the CAC. Meetings are held four times a year at the Plan’s office in Camarillo. These committee meetings are open to the public. Everyone is welcome to attend. If you would like more information or want an application, call 1-805-437-5562 . ■  ■ Do you know when you need a referral from your Primary Care Provider (PCP)? ■  ■ What is the difference between a referral and an authorization? ■  ■ Are you able to go to a non- contracted provider? What about a doctor that is out of the area? The rules of your health plan can be confusing. If you don’t follow them, your services may not be covered. Here is information to help you follow the rules of Gold Coast Health Plan (GCHP). Referrals. If you are assigned to a GCHP PCP, you must have a referral to see another doctor. Your PCP can make a direct referral to any other GCHP provider that is in the network within the county without authorization from GCHP. Authorized referrals. In most cases, your PCP will refer you to a doctor that has a contract with GCHP. If your PCP refers you to a doctor outside of the county, an authorization request must be sent to GCHP in advance. Prior authorization. GCHP has to approve some services before you get them. This involves some tests, medications and equipment. The doctor who is going to do the service must fill out a request for authorization . The doctor sends it to GCHP for review. If the request is medically necessary and a covered benefit, GCHP will approve it. The Plan will inform the doctor. You will then be able to get the service. If GCHP denies a request, the Plan will let you and the doctor know. You can file an appeal if you disagree with the denial. For other services that do not need a referral, see your Member Handbook. You can also call Member Services at 1-888-301-1228 / TTY 1-888-310-7347 . What are referrals and authorizations and when do I need them? Health Information Form member news Gold Coast Health Plan (GCHP) is interested in learning more about your health care needs. All newly-enrolled members will receive a Health Information Form (HIF) as part of their welcome packet. The HIF has 10 questions about your health care needs. The form is available in English and Spanish. Filling out the form is voluntary. Members will not be denied services if the form is not completed. All responses are confidential. New members will receive two reminder phone calls. Members will be asked to complete and return the yellow form in the provided yellow self-addressed stamped envelope. The Plan will review the completed form and make sure members receive the best possible care needed. If you have questions, call Member Services at 1-888-301-1228 / TTY 1-888-310-7347 . winning health 4