Resources – Members

Some members are offered coverage for services rendered by non-participating providers. When covered for out-of-network services, members are required to receive verification of medical necessity for those services rendered by non-participating practitioners in order for any reimbursement to be made by the health plan. Any services rendered beyond those approved as medically necessary will be the responsibility of the member.

Providers may assist the member by submitting documentation to support the medical necessity of services rendered. To access the appropiate instructions and forms, indicate the type of services you received from the list below:

• Acupuncture
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• Nutrition Services
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• Chiropractic
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• Physical, Occupational, and Speech Therapy
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• Massage Therapy
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• Physical Medicine
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• Naturopathy
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• Podiatry
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Confidential Communications Requests (AB 1184)
Health plans are required to accommodate requests for confidential communication of medical information. If you have a confidential communication request, please contact your health plan at the number on the back of your ID card.

• Authorized Personal Representative Form
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• California GRIEVANCE FORM
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• Non-California GRIEVANCE FORM
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• Appointment Of Authorized Representative Form
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To view and/or print pdf documents you will need  Acrobat Reader  installed.

• Quality Improvement Executive Summary
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• Patient Satisfaction Survey Results Summary
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• Provider Satisfaction Survey Results Summary
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• Clinical Practice Guidelines
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• Medicare Guidelines

• Statement of Members' Rights and Responsibilities

The Be Healthy Library includes informational resources that may increase your health care knowledge, which could benefit you through preventing injury, optimizing personal health behavior, and using the health care system more effectively.

• Acupuncture
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• Back Pain
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• Blood Pressure
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• Chiropractic
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• Fitness
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• Massage Therapy
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• Mental Health
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• Neck Pain
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• Osteoporosis
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• Pain
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• Preventive Health
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• Safety
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• Sleep
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• Stress Management
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• Tobacco
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• Weight Management
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