CalOptima

One of the worst organizations in Orange County, California. I work for a doctor, and we always obtain authorization approval for patients’ procedures before the doctor performs them. However, they have the audacity to DENY claims and say that our office never got the authorizations in advance. It’s just outrageous. Right now, we have to print out the claims (again), authorization letters, and remittance advice letters to appeal the claims. Simply absurd. Keep it up, CalOptima, more doctors will be fed up with this nonsense and stop seeing CalOptima patients. People that run this place need to be ashamed of themselves.

Been here about 5 times. Very little wait time (less than 5 minutes each time). Staff is very friendly and helpful.

AIDS testing, family planning, pregnancy services, and treatment for STDs do not need prior authorization. Everything they send is also in Spanish and Vietnamese. New member orientation is on the second Tuesday of every month so you can learn about your responsibilities and rights. Meetings in Vietnamese are held at the Midway City Community Center. You can ask for a free interpreter when you get health care or over-​the-​phone.
Benefits include authorized acupuncture, laboratory services (blood work, CT scan, ultrasound, and x-​rays), maternity care, and medications. Care management is available for those who have cancer treatments and spinal injuries. Children with chronic illness may be eligible for the California Children’s Services program if their families meet certain financial and residential requirements. Diapers, feeding tubes, and skin creams are available by prescription. If you are under 21 you may qualify for medical supplies, nutrition services, and physical therapy under through a federal program called Early and Periodic Screening, Diagnosis, and Treatment [EPSDT].
Minor consent/​sensitive services for drug abuse in children under age 12 or sexual assault do not need parental consent/​physician referral. Newborn care, nursing facility services, orthopedic referrals, pediatric checkups, and speech therapy are covered too. Perinatal support lasts for two months after the baby is born. Pharmacy services are limited to Orange County unless you use a contracted chain within the state. They also have classes for diabetes, quitting smoking, and stress management.