Let Member Services try to solve your problem first
Most problems can be resolved by one of our Member Services Representatives. If you have a problem, please call L.A. Care Medicare Plus Member Services first so that we may try to find a solution. You can call L.A. Care Medicare Plus Member Services, 24 hours a day, 7 days a week, including holidays.
Phone: 1-833-522-3767 (TTY: 711)
You can get help from the Ombuds Program
If you need help getting started, you can always call the Ombuds Program. The Ombuds Program can answer your questions and help you understand what to do to handle your problem. The Ombuds Program is not connected with us or with any insurance company or health plan. They can help you understand which process to use. The services are free. You can contact the Ombuds Program by phone at 1-855-501-3077.
You can get help from the Health Insurance Counseling and Advocacy Program (HICAP)
You can also call the Health Insurance Counseling and Advocacy Program (HICAP). The HICAP counselors can answer your questions and help you understand what to do to handle your problem. HICAP is not connected with us or with any insurance company or health plan. HICAP has trained counselors in every county, and services are free. You can contact the local HICAP office by:
Phone: 1-800-824-0780 or 1-213-383-4519 (TTY: 1-213-251-7920)
Getting help from Medicare
You can call Medicare directly for help with problems. Here are two ways to get help from Medicare, by:
Phone: 1-800-MEDICARE (1-800-633-4227) (TTY: 1-877-486-2048), 24 hours a day, 7 days a week.
Web: Visit the Medicare website at www.medicare.gov
Getting help from Medi-Cal
You can call the Ombuds Program directly for help with problems with Medi-Cal. You can contact the Ombuds Program by:
Phone: 1-888-452-8609
Web: Visit the Office of the Patient Advocate website at www.opa.ca.gov
You may also file a complaint with the Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) for California, Livanta. You may contact the BFCC-QIO by:
Mail: Livanta
BFCC-QIO Program
10820 Guilford Road, Suite 202
Annapolis Junction, MD 20701
Phone: 1-877-588-1123 (TTY: 1-855-887-6668), 24 hours a day, seven days a week
Fax: Appeals – 1-855-694-2929; All other reviews – 1-844-420-6672
Appointing a Representative
You can ask someone to act on your behalf. If you want to, you can name another person to act for you as your “representative” to ask for a decision or make an appeal.
If you would like to appoint a person to act on your behalf regarding authorizations or appeals issues, please fill out the Appointment of Representative Form and submit to us at the contact information above.
There may be someone who is already legally authorized to act as your representative under State law. Remember, you can limit the amount of information we share or the types of decisions your representative can make.
You can also appoint someone through:
Phone: Call Member Services at 1-833-522-3767 and ask for the Appointment of Representative Form, to give that person permission to act on your behalf.
Mail: You may also send a written statement authorizing the individual to act on your behalf. The form or statement must be signed by you and by the person who you would like to act on your behalf. You must give our Plan a copy of the signed form or statement indicating that the individual accepts the appointment. Please send the completed form or statement to:
L.A. Care Medicare Plus
Attn: Grievances & Appeals Unit
1055 W. 7th Street, 10th Floor
Los Angeles, CA 90017
Fax: Or fax the signed form or statement to 213-438-5748
You also have the right to hire a lawyer to act for you. You may contact your own lawyer, or get the name of a lawyer from your local bar association or other referral service. There are also groups that will give you free legal services if you qualify. However, you are not required to hire a lawyer to ask for any kind of decision or appeal a decision.
Download the Appointment of Representative Form.