We provide important information to help you navigate your healthcare experience. Our goal is to keep all members informed about the range of services we offer, from behavioral health to specialty care, and more. We are here to make it easier for you to find the information and services you need. See below for more member resources.
- Behavioral health: For mental health services provided by HPSM, call the San Mateo County Behavioral Health and Recovery Services (BHRS) ACCESS Call Center at 1-800-686-0101 (TTY 7-1-1).
- Benefit restrictions: Healthcare services provided to HPSM members are subject to terms, conditions, exclusions and limitations (including services obtained outside HPSM’s service area). Medi-Cal members can learn more in the Evidence of Coverage (EOC).
- Coverage for new technology: Requests for new technologies and experimental treatments are reviewed by HPSM. Approval may be given if you have a life threatening or seriously debilitating condition for which standard treatment has not worked, is not appropriate or is not covered by Medi-Cal.
- Filing complaints and appeals: If you are not satisfied with your medical care, the service provided by HPSM or your provider’s office, you can file a complaint or appeal. Learn more.
- Hospital care: In an emergency, call 9-1-1 or go to the nearest hospital. If you need hospital care and it is not an emergency, your primary care provider (PCP) will get you pre-approval and decide which hospital you should go to. You need to go to a hospital in the HPSM network. Learn more.
- Submitting claims for covered services: If you get a bill for a covered service, do not pay it. If you have already paid, call Member Services or the CareAdvantage Unit to find out how to get your money back. Or fill out the form.
- Service outside of business hours: You can still call HPSM or your PCP after regular business hours. (HPSM’s hours are Monday through Friday from 8:00 a.m. to 6:00 p.m.) For emergencies, call 9-1-1 or go to the nearest emergency room. If you are not sure it is an emergency, call the Nurse Advice Line at 1-833-846-8773.
- Service outside of California: For emergency healthcare while traveling, you may be able to see an out-of-network provider at no cost. To get authorization, call your PCP or Member Services or the CareAdvantage Unit right away. Learn more.
- Specialty care: If you need to see a specialist, your PCP will work with you to choose one, give you a referral and help you set up an appointment.
You can find more details in your Member Handbook / Evidence of Coverage (EOC).