PHC California

Rachel Sakai
AHF Provider

Covered Services

PHC California covers the following services with no copays or deductibles.  Limitations and rules on how to get care are below.  This information is also in the Membership Guide.  Look in Section 3.  If you have questions about covered services, please contact Member Services.

Services Provided   Limitations
Acupuncture Covered when medically necessary; no limits; no co-pay; requires prior authorization
Alcohol Abuse Treatment Available through the Los Angeles County Public Health Substance Abuse Prevention and Control Program. (By clicking on the link above, you will be taken to a website operated by Los Angeles County Public Health and not PHC California.)  PHC California will refer you for such services if you need them.
Allergy Care Covered when medically necessary; no limits; no co-pay; requires prior authorization
Ambulance Services For emergencies; covered when medically necessary; no limits
Ambulatory Surgery at an Ambulatory Surgery Center Covered when medically necessary; no limits; requires prior authorization
Behavioral Health Services Medically necessary emergency behavioral health services provided at a hospital emergency room are covered when the emergency room visit does not result in a psychiatric admission. Services that are within the scope of practice of a primary care provider (PCP) covered; no limits. Inpatient and outpatient mental health services available through the Los Angeles County Department of Mental Health. (By clicking on the link above, you will be taken to a website operated by the Los Angeles County Department of Mental Health and not PHC California.)  PHC California will refer you for such services if you need them.
Case Management and Disease Management Services Covered; no limits
Certified Nurse Midwife Services Covered; no limits
Certified Nurse Practitioner/Physician Assistant Services Covered when medically necessary; no limits; certain services require prior authorization
Chiropractic Services Covered when medically necessary; limited to two (2) services per month; limited to the treatment of the spine by means of manual manipulation; procedures require prior authorization
Clinical Services from Federally Qualified Health Care Centers (FQHCs) and Indian Health Clinics Primary care and preventive physician services covered; limit of one (1) visit per day
Clinical Services from Los Angeles County Health Services Clinics Primary care and preventive physician services covered; limit of one (1) visit per day
Clinical Services from Rural Health Clinics (RHCs) Primary care, preventive physician and laboratory services covered; limit of one (1) visit per day; certain laboratory services require prior authorization
Dermatology Services Covered when medically necessary; no limits; certain services require prior authorization
Dialysis Services (hospital-based and free standing) Covered when medically necessary; no limits; requires prior authorization
Durable Medical Equipment and Medical Supplies Covered when medically necessary; certain items and services require prior authorization.
Emergency Room Services Covered when medically necessary; no limits
Family Planning Services Covered; no limits.  Available through any participating Medi-Cal provider.
Hearing Services and Aids Covered when medically necessary; no limits; certain services require prior authorization
Home Health Care Services Covered when medically necessary; no limits; requires prior authorization
Hospice Services Covered when medically necessary; limited to 390 days per lifetime; requires prior authorization
Immunizations Covered; no limits
Inpatient Hospital Services Covered when medically necessary; no co-pay; requires prior authorization. Inpatient hospital services are covered under Regular Medi-Cal (fee-for-serivce) and are authorized by PHC California.
Investigational Services Covered when conventional therapies will not adequately treat condition or prevent disability or death; no limits; requires prior authorization
Laboratory/X-Ray/Imaging Services Covered when medically necessary; no limits; certain services require prior authorization
Long Term Care Covered when medically necessary; no limits; requires prior authorization
Maternity Services, including:

  • Hospital Inpatient Care
  • Physician Care
  • Pharmacy
Covered when medically necessary; no limits; certain services require prior authorization
Medical/Drug Treatment Therapies Covered when medically necessary; no limits; requires prior authorization
Ophthalmology Services Covered when medically necessary; no limits; requires prior authorization
Outpatient Hospital Services Covered when medically necessary; no limits; requires prior authorization
Outpatient Surgery (Hospital) Covered when medically necessary; no limits; requires prior authorization
Optometric and Vision Services Routine eye exams and prescriptions for eye glasses/corrective lenses covered. No limits.  Eyeglasses are covered for members under the age of 21 and pregnant women through postpartum.
Outpatient Rehabilitation Services

  • Cardiac Rehabilitation
  • Pulmonary Rehabilitation
Covered when medically necessary; no limits; no co-pay; requires prior authorization
Physician Primary Care Services Covered; limited to one (1) visit per day
Physician Specialty Care Services Covered when medically necessary; limited to one (1) visit per day per specialist; referral and/or prior authorization required
Podiatry Services Covered when medically necessary; no limits; certain services require prior authorization
Prescription Drugs Covered when medically necessary; no limits; prior authorization required on certain drugs; quantity limits on certain drugs
Prosthetic and Orthotic Appliances Covered when medically necessary; no limits; requires prior authorization
Sexually Transmitted Disease (STD) Testing, Counseling and Treatment Covered; no limits; available through any participating Medi-Cal provider
Skilled Nursing Facility Services Covered when medically necessary; no limits; requires prior authorization
Substance Abuse Treatment Heroin detoxification covered; limited to 21 days per year; requires prior authorization. Treatment for other substance abuse available through the Los Angeles County Public Health Substance Abuse Prevention and Control Program. (By clicking on the link above, you will be taken to a website operated by Los Angeles County Public Health and not PHC California.) PHC California will refer you for such services if you need them.
Therapy Services (Hospital- and Community-Based) including:

  • Occupational Therapy
  • Physical Therapy
  • Speech Therapy
Covered when medically necessary; no limits; requires prior authorization
Transplant Services Kidney transplant covered when medically necessary; no limits; requires prior authorization. Other major organ transplants covered under Regular Medi-Cal (fee for service) and require disenrollment from the plan.
Transportation (Non-Emergency) Covered; no limits; plan must arrange transportation to and from plan-approved locations
Tuberculosis Diagnosis and Treatment Services Covered; no limits; requires prior authorization.  Direct-observed therapy, when medically necessary, is provided by the Los Angeles County Department of Public Health.  PHC California will refer you for such services if you need them.

 


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The benefit information provided is a brief summary, not a complete description of benefits.  Limitations and restrictions apply.  Benefits, formulary, and/or pharmacy network may change.

DHCS 030716 PHC Form 1.0