Living Healthy Prescription drugs If you are a Medi-Cal member, your prescriptions that are filled at a pharmacy are covered by Medi-Cal Rx, not the Alliance. You can view prescription drugs that are covered by MediCal Rx at www.medi -calrx.dhcs.ca.gov, or you can request a printed copy by calling 800-977-2273 (TTY: Dial 711), 24 hours a day, 7 days a week. If you are an IHSS member, pharmacy services are managed by MedImpact. You can view covered prescription drugs on the Alliance website at www.thealliance .health/prescriptions. You can also request a copy by calling Member Services at 800-700-3874 (TTY: Dial 711), Monday through Friday, 8 a.m. to 5:30 p.m. You may also call Member Services if you have questions about a medication. GETTING AN APPOINTMENT: How long should you have to wait? As a member of the Alliance, it is your right to have timely access to network providers, but sometimes it is not possible for a doctor to see you right away. Some appointments might take longer to schedule than others. We work with the doctors and clinics in our network to make sure you can get care when you need it. Health plans in California have to meet certain standards for access to care. The regulations to put this law into place are called the Timely Access to Non-emergency Health Care Services standards. The chart below lists the standards for different types of appointments. The waiting times for an appointment may be longer if the provider feels that it will not harm your health. If they feel a longer wait time would not be harmful to your health, they must note it in your medical record. If you feel you are not getting care when you need it, call Member Services at 800-700-3874 (TTY: 800-735-2929 or 711). Appointment type You should be able to get an appointment within: Urgent care appointments that do not require preapproval (prior authorization) 48 hours Urgent care appointments that do require pre-approval (prior authorization) 96 hours Non-urgent (routine) primary care appointments 10 business days Non-urgent (routine) specialist care appointments 15 business days Non-urgent (routine) mental health provider (non-doctor) care appointments 10 business days Non-urgent (routine) appointments for ancillary (supporting) services for the diagnosis or treatment of injury, illness or another health condition 15 business days Other wait time standards You should be able to get connected within: Member services telephone wait times during normal business hours 10 minutes Telephone wait times for Nurse Advice Line 30 minutes (connected to nurse) 6
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