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Your medical home is responsible for making sure you get the medical care you need and are entitled to.
- You were asked to choose a medical home when you applied for HWLA.
If you did not get the medical home you chose, call HWLA at 1-877-333-4952 to see if the medical home is now available. Each member has a medical home.
Your Medical Home
Your medical home gives you “primary” (or basic) medical care. Health care services you can get from your medical home include:
- Routine care.
- Checkups (also called “well visits”). This is when you go to your medical home when you are not sick. It is important to see your doctor when you are not sick!
- Sick care. These visits are when you see your doctor because you are not feeling well.
- Referrals to specialists.
When you need a checkup or if you get sick, you need to go to your medical home. Call your medical home for an appointment. The phone number is on your ID card.
Call Your Medical Home
Your first visit is important. Within the first 120 days after you join HWLA, your doctor is required to give you an initial health assessment. This means that he/she will look at your medical history, find out what your health status is today, and can begin any new treatment you might need. You and your doctor will also talk about preventive care. This is care that helps “stop” you from getting sick or keeps certain conditions from getting worse.
How to see your medical home doctor:
- Call your medical home’s office to schedule an appointment. You should get an appointment within 30 business days from the date of your call. Your medical home’s phone number is on your ID card. Be sure to call only your medical home and not another clinic, or they will refer you back to your medical home.
- Be on time for your appointment. If you need directions, call your medical home.
- If you can’t go to your appointment, call your medical home right away. By canceling your appointment, you allow someone else to be seen by the doctor.
- If you miss your appointment, call right away to make another appointment.
- Bring your ID card with you when you visit your medical home.
Important! You can still get services without your ID card. Your medical home can call HWLA Member Services so you can get care.
How To Get Care When Your Medical Home Is Closed
If you need care when your medical home is closed (such as after normal business hours, on the weekends or holidays), call the Nurse Advice Line number that is on your ID card. This number is available to you 24 hours a day, seven (7) days a week, to help answer your health care questions and have your health concerns and symptoms reviewed by a registered nurse. The nurse will let you know if you need to see a doctor right away or if there is something you can do at home to feel better. This service is free of charge and available to you in your language.For urgent care (this is when a condition, illness or injury is not life-threatening, but needs medical care right away), call or go to the nearest HWLA urgent care center. Urgent care centers are listed in the Provider Directory under the section "Urgent Care Centers".
If You Get A Bill
HWLA is a no-cost health care program. That means it is no cost to you. You should not get a bill for any services provided in the HWLA Network and covered by HWLA. Please call HWLA right away if you receive a medical bill. You may get a medical bill if you go to an emergency room that is not in the HWLA network or is located outside of L.A. County. If this happens, then you may be billed. Do not pay the medical bill. Instead, call Member Services for instructions on where to mail the bill.
What Is A Second Opinion?
You have the right to ask for and get a second opinion at no cost to you. You also have the right to ask for a timely response to your request for a second opinion. A second opinion is a visit with another doctor when:
- You question a diagnosis for a chronic condition or for a condition that endangers your life or body. (A diagnosis is when a doctor identifies a specific condition, illness or disease.)
- You do not agree with your medical home doctor or specialist’s treatment plan. (A treatment plan is the care that the doctor says is best for you, based upon the doctor’s diagnosis.)
- You would like to make sure your treatment plan is right for you.
The second opinion must be from a qualified health care professional in the HWLA Program network. (A qualified health care professional is a person who has the training and expertise to treat or review a specific medical condition.)
How To Get A Second Opinion To get a second opinion:
- Talk to your medical home doctor and let him/her know you would like to see another doctor and the reason why.
- Your medical home doctor will refer you to a qualified health care professional. If you are requesting a second opinion about a diagnosis that your medical home doctor made, the second opinion will be from a doctor of your choice from the same medical home. If you are requesting a second opinion about a diagnosis that your specialist made, a second opinion must come from a specialist in the network.
- Bring your ID card to the second opinion appointment.
You may complain to HWLA if your medical home or doctor denies your request for a second opinion or if you do not agree with the second opinion. This is also called “filing a grievance.” For more information on filing a grievance, see the “Complaints” section of this handbook.