Los Angeles, Orange, San Bernardino and Riverside Counties
Alameda, Contra Costa, Fresno, San Joaquin, San Mateo, and Santa Clara Counties
Ventura County

Central Health Medicare Plan (HMO) Plan Provider Directory 2024

This directory is current as of September 01, 2023.

This directory provides a list of Central Health Medicare Plan’s current network providers for Los Angeles County, Orange County, Riverside County, San Bernardino County, Ventura County, Alameda County, Contra Costa County, Fresno County, San Joaquin County, San Mateo County, and Santa Clara County.

To request a hard copy of Central Health Medicare Plan’s provider directory, please call our Member Services Department at 1-866-314-2427, 7 days a week from 8:00am to 8:00pm (PT). Central Health Medicare Plan will mail a hard copy of the provider directory to you within three (3) business days of your request. Central Health Medicare Plan may ask whether your request for a hard copy is a one-time request or if you are requesting to receive the provider directory in hard copy permanently.

If you request it, your request for hard copies of the provider directory remains until you leave Central Health Medicare Plan or request that hard copies be discontinued.

Introduction

This directory provides a list of Central Health Medicare Plan's network providers.

Use this directory to find Central Health Medicare Plan’s network providers for your care needs. Network Providers are the doctors and other health care professionals, medical groups, hospitals, and other health care facilities that have an agreement with us to accept our payment and any plan cost sharing as payment in full. We have arranged for these provider to deliver covered services to members in our plan.

You will have to choose one of our network providers listed in this directory to be your Primary Care Provider (PCP). Generally, you must get your health care services from your PCP. Your PCP is a physician who meets state requirements and is trained to give you basic medical care. You will get your routine or basic care from your PCP. Your PCP can also coordinate the rest of the covered services you need. In most cases, you must see your PCP to get a referral before you see any other health care provider.

The network providers listed in this directory have agreed to provide you with your health care services. You may go to any of our network providers listed in this directory; however, some services may require a referral. If you have been going to one network provider, you are not required to continue to go to that same provider. In some cases, you may get covered services from out-of-network providers.

Central Health Medicare Plan maintains a standard for appointment wait times for all network providers. Members should receive care from network providers within the following timeframes:

• For routine or preventive care: 30 business days
• When you require medical attention, but it is not an emergency: 7 business days
• For urgent or emergency care: immediately

What if you use out-of-network providers to get covered services?

Out-of-network providers are providers that are not part of Central Health Medicare Plan. If you use out-of-network providers, you may have to pay more. Care or services you get from out-of-network providers will not be covered, except for ambulance services, emergency care, including post-stabilization care, urgently needed care, renal dialysis (kidney), and any services which were ordered covered through an appeals process.

What if you receive a bill from an out-of-network provider?

If an out-of-network provider sends you a bill for covered services that you think should be paid by our plan, DO NOT pay the bill. Please contact Member Services at 1-866-314-2427. TTY users call 711. We will ask you to send the bill to us so that we can process and determine the amount you owe, if any. If you have already paid for any medical care that we cover, we will reimburse you for our share of the cost.

How to get covered services when you have an emergency?

When you have a “medical emergency,” you believe that your health is in serious danger. A medical emergency can include severe pain, a bad injury, a sudden illness, or a medical condition that is quickly getting much worse.

If you have a medical emergency:

• Get help as quickly as possible. Call 911 for help or go to the nearest emergency room or hospital. Call for an ambulance if you need it. You do not need to get approval or a referral first from your PCP.
• As soon as possible, make sure that our plan has been told about your emergency. We need to follow up on your emergency care. You or someone else should call to tell us about your emergency care, usually within 48 hours. Please refer to the information provided on the back of your membership card for specific directions and appropriate phone numbers to call.

After the emergency is over you are entitled to follow-up care to be sure your condition continues to be stable. Your follow-up care will be covered by our plan. If your emergency care is provided by out-of-network providers, we will try to arrange for network providers to take over your care as soon as your medical condition and the circumstances allow.

How to get urgently needed care?

“Urgently needed care” is a non-emergency situation when:

• You need medical care right away because of an illness, injury, or condition that you did not expect or anticipate, but your health is not in serious danger.
• Because of the situation, it isn’t reasonable for you to obtain medical care from a network provider.

Whenever possible, you must use our network providers when you are in the plan’s service area and you have an urgent need for care. In most situations, if you are in the plan’s service area, we will cover urgently needed care only if you get this care from a network provider. If the circumstances are unusual or extraordinary, and network providers are temporarily unavailable or inaccessible, our plan will cover urgently needed care that you get from a non-network provider.

You must use network providers except in emergency or urgent care situations or for out-of-area renal dialysis or other services. If you obtain routine care from out-of-network providers neither Medicare nor Central Health Medicare Plan will be responsible for the costs.

What is the service area for Central Health Medicare Plan?

The counties in our service area are listed below.

Alameda County
Contra Costa County
Fresno County
Los Angeles County
Orange County
Riverside County
San Bernardino County
San Joaquin County
San Mateo County
Santa Clara County
Ventura County

How do you find Central Health Medicare Plan providers that serve your area?

The PCPs in this directory are organized alphabetically by the cities where they reside, and further listed in alphabetical order by last name within each city. By looking up the city in which you reside, you will be able to find the physicians listed in your area. The specialty care providers (specialists) are organized alphabetically by the physician groups they belong to. If there is a particular plan specialist that you want to use, check first to be sure your PCP makes referrals to that specialist. Your PCP choice may restrict you to a specific group of specialists. If you have questions about Central Health Medicare Plan or require assistance in selecting a PCP, please call our Member Services Department at 1-866-314-2427, 7 days a week, 8:00 A.M. to 8:00 P.M. (PT). TTY users should call 711. You can also visit www.centralhealthplan.com.

List of Network Providers

Total Number of Primary Care Physicians	2,097
Total Number of Specialists	5,552
Total Number of Hospitals	77
Total Number of Skilled Nursing Facilities	282
Total Number of Behavioral Health Providers	105

* Providers noted with an asterisk accept Medicare and Medi-Cal.
† Providers noted with this symbol are not currently accepting new patients.