Support & Information

Urgent care is not for an emergency or life-threatening condition. It is for services you need to prevent serious damage to your health from a sudden illness, injury or complication of a condition you already have.

For urgent care, call your PCP. If you cannot reach your PCP, call call us at +1.888.893.1569 TTY 711. Members should contact PCP or Member Services before going to an Urgent Care Center.

You can ask for someone to help you talk with your provider in your language. This is an interpreter. To ask for an interpreter at no cost to you, please call us at +1.888.893.1569 TTY 711 . You will need to have your member ID number when you call.

You have the right to get full and equal access to health care services covered by CalViva Health. This is also true if you have a disability, according to the following laws:

1) The Americans with Disabilities Act of 1990 and
2) Section 504 of the Rehabilitation Act of 1973.

Did you find something you think might be wrong in our network of health care providers? Please let us know so we can fix it. You may call us at +1.888.893.1569 TTY 711 . You may also contact us by email at directoryrequest@calvivahealth.org or using this form.

If you feel the provider directory has given wrong, partial, or deceptive information, you may file a complaint. To file a complaint, use this link https://www.calvivahealth.org/benefits/grievance-form/ or contact our Member Service Department at +1 .888.893.1569 TTY 711 . You can also contact us by mail.

Send your complaint to:
CalViva Health, Attn: Grievance and Appeals Department C-5, 21281 Burbank Blvd., Woodland Hills, CA 91367, Fax: 1.877.831.6019

When you enroll with CalViva Health, you will select a primary care physician (PCP); a PCP is a doctor who will be your personal doctor. Your PCP may be a family practice, general practice, internal medicine, obstetrics and gynecology (OB/GYN) or pediatrics (for your children) physician. You may want to have one doctor who will see your whole family, or you may want to have one doctor for you and a different doctor for your children.

Your PCP will be the doctor you will see when you are sick; he or she will refer you to a specialist and coordinate your health care whenever you need it. You must always see your PCP each time you need medical treatment unless it is an emergency. You do not need to get a referral from your PCP to visit your eye doctor for a regular examination, for a family planning visit, or for care during pregnancy.

Your PCP will know whether you need an authorization or whether you can make the appointment directly. Remember, Emergency Care, Urgent Care or care with an OB/GYN in your network, Family Planning Services, HIV testing and counseling, pregnancy termination, Sexually Transmitted Disease (STD) services do not require a Referral.

For religious or ethical reasons, some Hospitals and other Providers do not provide one or more of the following services that may be covered under your plan contract and that you or your family member might need. These services are available to you from other Providers or Hospitals:

1. Family Planning Services
2. Contraceptive services, including emergency contraception
3. Sterilization, including tubal ligation at the time of labor and delivery
4. Abortion

If you need help finding a provider, call Member Services at +1.888.893.1569 TTY 711 .

Below is information used in the provider directory to indicate different types of clinics.

CC – Community Clinic COO – County-Owned &/or Operated Clinic

FQHC – Federally Qualified Health Center

MXCL – Mixed Specialty Clinic

RHC – Rural Health Clinic

TIHC – Tribal/Indian Health Clinic

DSHC – Disproportionate Share Hospital Clinic

When you need medical care, it is important to get it promptly. The amount of time before your appointment depends on your health condition. It also depends on the type of care you need. Business Days is the number of working days, typically Monday through Friday, before your appointment. Business Days do not include weekends and holidays. Here is a general idea of how many business days you may need to wait for the appointment:

• Within 10 business days – Routine care appointment with your primary care physician (PCP) – your main doctor
• Within 15 business days – Routine care appointment with a specialist (when your PCP refers you)
• Within 48 hours – Urgent appointment for services that do not need approval in advance
• Within 96 hours – Urgent appointment for services that need approval in advance (prior authorization)
• Within 2 weeks – First prenatal visit
• Within 10 business days – Well-child visit with a PCP
• Within 30 calendar days – Physical exam/preventive checkup
• Within 15 business days – Ancillary testing (such as labs, X-rays or therapy services that you cannot get in your doctor’s office)

Language services can be coordinated with scheduled appointments for health care services so that an interpreter is available at the time of the appointment. If you need help making an appointment, call Member Services at +1.888.893.1569 TTY 711.

CalViva Health must follow travel time and distance standards for your care. The table below shows this travel time and distance standard. If CalViva Health is not able to provide care to you within these travel time and distance standards, a different standard called an alternative access standard may be used. To see CalViva Health’s alternative access standard, please click here.

If CalViva Health cannot find care for you with a closer specialist, you can request CalViva Health arrange transportation for you to see a specialist even if that specialist is located far from where you live. It is considered far if you cannot get to that specialist within the CalViva Health’s travel time and distance standards for your county, regardless of any alternative access standard CalViva Health may use for your ZIP Code.

1 DHCS Adult and Pediatric Core Specialists

The glossary of terms and abbreviations below will help you better understand the way our Provider Directory lists accessibility information for each location.

Accessibility Requirements Basics

Facility represents all six accessibility requirements. Limited: Facility is missing one or more of the six accessibility requirements.

Indicator, Definition and Criteria

P – Parking: Parking spaces are accessible, including spaces for vans. Pathways have curb ramps between the parking lot and office and at drop-off locations.

EB – Exterior Building: Curb ramps and other ramps to the building are wide enough for a wheelchair or scooter. Handrails are provided on both sides of the ramp. Doors open wide enough to let a wheelchair or scooter enter, and have handles that are easy to use.

IB – Interior Building Interior ramps are wide enough for a wheelchair or scooter. Handrails are provided. Doors open wide enough to let a wheelchair or scooter enter, and have handles that are easy to use. Stairs, if present, have handrails. The elevator has easy-to-hear sounds and Braille buttons within reach. The elevator has enough room for a wheelchair or scooter to turn around. If there is a platform lift, it can be used without help.

R – Restroom The restroom doors open wide enough to let a wheelchair or scooter enter. The restroom stall is large enough to turn the wheelchair or scooter around and close the door. There are grab bars to allow easy transfer from wheelchair to toilet. The toilet paper is easy to reach. The sink is easy to get to and the faucets, soap and paper towels are easy to reach and use.

PD – Patient Diagnostic and Treatment Use: Patients are able to access and use testing and treatment areas, and equipment.

PA – Participant Areas: Members can get to and use all common areas and equipment with or without help.

E – Exam Room: The entrance to the exam room is accessible, with a clear path. Doors open wide enough to let a wheelchair or scooter enter, and have handles that are easy to use. The exam room has enough room for a wheelchair or scooter to turn around.

T – Exam: Table/Scale The exam table moves up and down. The scale is accessible with handrails to assist people with wheelchairs and scooters. The weight scale is able to accommodate a wheelchair.