Frequently Asked Questions

If you do not see your question answered here, please call CalOptima’s Customer Service department at the numbers below. We are here to help you and make sure you get access to the best health care possible.

The BIC is a card issued by the County of Orange Social Services Agency. It is used to obtain Medi-Cal covered services. The CalOptima ID card is issued by CalOptima Medi-Cal. The CID card helps to identify you as a CalOptima member. It is important to have all health insurance cards with you and present them to your provider when you access health care services.

If you lose your BIC, call or visit your local County of Orange Social Services Agency. Click here for a list of offices. If you lose your CalOptima ID card, call CalOptima’s Customer Service department at the numbers below.

You may change your PCP for any reason every 30 days. Your health network's member services department can assist you in changing PCPs. Their number is on your CalOptima ID card.

If the PCP you selected is not affiliated with your current Health Network, you may have to change your Health Network. Your health network will ask that you call us to change your PCP and health network. If you have questions, please call CalOptima’s Customer Service department at the numbers below.

You may change your health network every 30 days. Call CalOptima’s Customer Service department to change your health network. You may have to change your PCP if the health network you selected is not affiliated with your current PCP.

Share-of-cost (SOC) is a set amount you must pay to providers each month before you are eligible for Medi-Cal benefits through CalOptima. The County of Orange Social Services Agency will tell you if you have a SOC and how much you will have to pay each month.

If you have a SOC (see question above), you will need to pay that amount each month to your provider. There are no other co-payment, premiums or out of pocket expenses if you see and receive Medi-Cal covered benefits through a Medi-Cal provider.

Ask your PCP for a referral. Your health network is responsible for authorizing referrals to specialists, for medical services and for medical supplies. The response time for routine prior authorizations is 5 working days and 24 hours for urgent prior authorizations.

Your doctor or specialist should let you know when a decision has been made. You can also call CalOptima’s Customer Service department at the numbers below.

If you received your health care from your CalOptima Medi-Cal provider, you should not be balanced billed for any Medi-Cal covered services. Call the provider who billed you. Give the provider your CalOptima Medi-Cal ID and/or other insurance information. If you get another bill or are sent to collections, call CalOptima’s Customer Service department at the numbers below for help.

Your other health insurance is the primary payer and is responsible for covering the services you received. CalOptima Medi-Cal is the last payer. First, you have to ask your primary insurance for payment for services before CalOptima (Medi-Cal) will pay.

After-hours care is when you need medical attention after your doctor's office is closed. If you need after-hours care:

If you are outside of Orange County and have an emergency or need urgent care:

Do not go to the hospital emergency room for general health care services. Call your doctor about general health care services.

Mental health is also called behavioral health. CalOptima covers mild to moderate behavioral health services. However, specialty mental health services is provided by Orange County Health Care Agency Behavioral Health. Community-based organizations are also available. CalOptima members can access benefits by calling CalOptima Behavioral Health at 1-855-877-3885, 24 hours a day, 7 days a week. We have staff who speak your language. TTY users can call 711.

On January 1, 2022, the Department of Health Care Services (DHCS) will change your pharmacy benefit. Your prescription medications will be covered by “Medi-Cal Rx.” DHCS is working with a new contractor (Magellan) to provide Medi-Cal Rx services.

This does not change your Medi-Cal eligibility or benefits. Starting on January 1, 2022 you will get your Medi-Cal covered prescriptions through Medi-Cal Rx instead of CalOptima.

If you have general Medi-Cal Rx questions, contact the DHCS Medi-Cal Member Help Line at 800-541-5555. For TTY call 800-430-7077 Monday through Friday from 8 a.m. to 5 p.m.

On January 1, 2022, the Department of Health Care Services (DHCS) will change your pharmacy benefit. Your prescription medications will be covered by “Medi-Cal Rx.” DHCS is working with a new contractor (Magellan) to provide Medi-Cal Rx services.

This does not change your Medi-Cal eligibility or benefits. Starting on January 1, 2022 you will get your Medi-Cal covered prescriptions through Medi-Cal Rx instead of CalOptima.

If you have general Medi-Cal Rx questions, contact the DHCS Medi-Cal Member Help Line at 800-541-5555. For TTY call 800-430-7077 Monday through Friday from 8 a.m. to 5 p.m.

Denti-Cal is the Medi-Cal Dental Program under the guidance of the California Department of Health Care Services. Denti-Cal provides dental care for CalOptima members. To contact Denti-Cal, call toll-free at 1-800-322-6384. TDD/TTY users can call toll-free at 1-800-735-2929.

Vision care services are provided to eligible CalOptima members through Vision Service Plan (VSP). To find out if you are eligible, please call CalOptima’s Customer Service department at the numbers below.

We need your correct name, address and phone number to contact you about your health care. If it changed you have to call:

You can speak with your CalOptima health care providers in the language of your choice. Many of our providers and staff speak your language. Our over-the-phone interpreter service is available to you 24 hours a day at no cost.

You can also ask for a face-to-face interpreter for your health care services. You do not have to ask family members or friends to interpret for you. For example, you can ask for an interpreter to be with you at your doctor visit if your doctor or the office staff does not speak your language. You need to ask for an interpreter at least 5 working days before your doctor’s appointment or at the same time you make the appointment.

If you feel your language needs are not being met, you can file a complaint with CalOptima. For help with interpreter services, call CalOptima’s Customer Service department at the numbers below.