Where Can I Get Care?
The State of California is the designated service area for HPSM’s Medi-Cal program. Service Area means the geographic area served by HPSM and approved by the State of California Department of Managed Health Care (DMHC). If you need covered health care services while outside of California, you may be able to get them from out-of-network providers at no cost to you as long as they are medically necessary and not available in HPSM’s network. Out-of-network providers are those that do not have an agreement to work with HPSM.
Need non-emergency care outside of the HPSM service area?
- call your PCP right away to get authorization to be treated
- or call Member Services at 1-800-750-4776 (TTY 1-800-735-2929 or dial 7-1-1)
Continuity of Care
If you are a new HPSM Medi-Cal member and see providers who are not in the HPSM network, you may be able to keep seeing them for up to 12 months if you meet certain conditions. To request continuing care or get a copy of our Continuity of Care policy,
please call Member Services. If your providers do not join the HPSM network by the end of 12 months, you will need to switch to providers in the HPSM network.
Getting Care Outside of California
If you need emergency care outside of California, including U.S. territories (American Samoa, Guam, Northern Mariana Islands, Puerto Rico and the Virgin Islands) tell the hospital or emergency room doctor as soon as possible that you have Medi-Cal and are an HPSM member. You are covered for emergency care, but not all hospitals and doctors accept Medicaid (which is what Medi-Cal is called in other states). Ask the hospital to make copies of your ID cards. Tell them to bill HPSM.
If you get a bill for services you received out of the state of California, call Member Services immediately. We will work with the hospital and/or doctor to arrange for HPSM to pay for your care. If you have questions about out-of-network or out-of-area care, call HPSM Member Services. If the office is closed or you want help from a representative, call our 24 hour nurse advice line at 1-833-846-8773.
If you travel to Canada or Mexico and need emergency services requiring hospitalization, HPSM will cover your care. If you pay for emergency services requiring hospitalization in Mexico or Canada, you can ask HPSM to pay you back. HPSM will review your request.
If HPSM agrees to pay you back, you will be paid the amount that HPSM would have paid your provider. This may be less than the amount that you paid.
If you are traveling internationally outside of Canada, Mexico or another state or U.S. territory and need emergency care, HPSM will not cover your care in most cases.
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