How can I enroll with the Alliance? You can enroll with the Alliance if you qualify for Medi-Cal, Healthy Families, Healthy Kids and live in Alameda County. If you are an In-Home Supportive Services (IHSS) home care worker, you can enroll in Alliance Group Care if you work in Alameda County.
If you qualify for Medi-Cal without a share of cost, then you may choose the Alliance as your Managed Health Care Plan, on the Medi-Cal Choice Enrollment form. You can request an enrollment form from your eligibility worker, or call Health Care Options at 1-800-430-4263 or you may call the Alliance Marketing Department at 1-877-371-2222 between the hours 9a.m.- 5p.m., or email directly to marketing@alamedaalliance.org. Send the complete form to Health Care Options for processing. Health Care Options generally takes up to 45 days to process the application and once you have been approved, you will receive a letter of confirmation informing you of the effective date of enrollment with Alameda Alliance for Health.
If you have children ages 0-19, who are U.S. citizens or legal residents and do not qualify for Medi-Cal, they may be eligible for our Healthy Families Program. Healthy Families offers low cost insurance for kids starting at $4.00 a month per child. If you would like more information about Healthy Families or an application, you can contact the Healthy Families Program at 1-800-880-5303 or the Alliance Marketing Department at 1-877-371-2222 between the hours 9am-5pm, or email directly to marketing@alamedaalliance.org. The Alliance offers Healthy Families application assistance in person or by telephone. Please call the Alliance Marketing Department to arrange an appointment.
Alliance Group Care was specifically designed for In-Home Support Service (IHSS) home care workers working in Alameda County. If you are an IHSS home care worker and are interested in applying for Alliance Group Care, please contact the Public Authority at (510) 577-3551 or the or Alliance Member Services at (510) 747-4567, 8 a.m. to 6 p.m., Monday through Friday, or email memberservices@alamedaalliance.org.
What services does the Alliance cover?
The Alliance covers most of your medical and prescription benefits. Some Alliance plans provide dental and/or vision benefits.
Does the Alliance cover dental services? Most Alliance Plans offer Dental Benefits through other carriers.
If you have Medi-Cal, your dental care is covered by Denti-Cal. You may contact Denti-Cal for more information, including dental referrals at: 1-800-322-6384.
If you have Healthy Families, your dental care is covered through a Healthy Families dental plan. Please call the Healthy Families Program at 1-866-848-9166. For more information about dental services.
Does the Alliance cover mental health/ drug and alcohol counseling services? All Alliance plans cover mental health and drug and alcohol counseling services. These services are offered through provider referrals. For Medi-Cal members call ACCESS at (510) 346-1000 (in Oakland), 1-800-491-9099 (outside of Oakland). For all other plans, please call PacifiCare Behavioral Health (PBH) at 1-888-789-7110 or view their website at www.pbhi.com.
Does the Alliance cover vision services? If you are enrolled with the Alliance through Medi-Cal, you are eligible for a routine eye exam and glasses every 24 months. You can choose an optometrist (eye doctor) who accepts VSP (Vision Service Plan) insurance, and call them directly to make an appointment. If you would like to know if you are eligible for services or need a list of eye doctors, you can call VSP directly at 1-800-877-7195.
Healthy Families members are also eligible for vision services through Healthy Families vision plan. Please call Healthy Families at 1-888-747-1222 for more information regarding vision benefits.
Vision services are covered for Group Care members.
If you are enrolled in Alliance Group Care, you are eligible for a routine eye exam and glasses every 24 months. You can choose an optometrist (eye doctor) who accepts VSP (Vision Service Plan) insurance, and call them directly to make an appointment. If you would like to know if you are eligible for services or need a list of eye doctors, you can call VSP directly at 1-800-877-7195.
Does the Alliance have any health education classes? The Alliance provides free health education classes for our members, including pre-natal education, smoking cessation classes, and CPR. If you would like information on our health education classes, please contact Health Education at (510) 747-4577, Monday through Friday, 8 a.m. -5 p.m.
Does the Alliance cover family planning and OB/GYN services? Yes, the Alliance covers family planning and OB/GYN services, including routine gynecological exams, sexually transmitted disease services, birth control, prenatal care, and abortions. Please contact Member Services at (510) 747-4567, 8 a.m. to 6 p.m., Monday through Friday for more information.
What do I need to do to in order to see a specialist?The first thing you should do is talk to your PCP (Primary Care Provider). Your PCP will be able to get the necessary authorization from the Alliance in order to refer you to a network specialist that accepts the Alliance.
For non-urgent specialist referrals, the authorization may take up to 2 weeks, so please be patient and make it a point to talk to your doctor before the matter becomes more complicated.
I went to the Emergency Room for a broken ankle, and I was told that I need to go to an
orthopedist for follow-up care. Do I need an authorization to go to the orthopedist?If the follow-up care is related to a bone fracture (broken bone) or sprain, you may see an orthopedist who accepts the Alliance, within 90 days of your visit the Emergency Room (ER), without an authorization. You can call the orthopedist office directly to make an appointment. If you need a name of an orthopedist who accepts the Alliance, please call our Member Services department for referrals.
Any follow-up visits to an orthopedist, after 90 days from your first visit to the ER, will need an authorization. Please see your PCP to request authorization.
I have Kaiser as my PCP through the Alliance and Medi-Cal, how do I obtain services?
If you have Kaiser as your PCP, you must get your services at Kaiser, including medical, OB/GYN, vision and prescriptions. If you go to any doctor or pharmacy outside of Kaiser, your services may not be covered.
One exception is mental health/ drug and alcohol counseling services. If you are seeking mental health/ drug and alcohol counseling, please call Access Mental Health at 1-800-491-9099. Another exception is emergency care. You may go to the nearest Hospital Room in an emergency.
Please remember that if you have Medi-Cal and would like to have Kaiser as your primary care facility, you need to contact the Alliance Member Services to inform us of your choice. If you do not call us to choose Kaiser as your PCP, we cannot guarantee that services will be covered, even if Kaiser accepts to see you for an appointment.
If you have any questions about Kaiser services or need a Kaiser Identification card, please call Kaiser Member Services at 1-800-464-4000.
I have been informed that my Medi-Cal benefits are on hold. What should I do?
If your Medi-Cal benefits are on hold, you should contact Social Services to talk to your eligibility technician regarding the hold. The eligibility technician will inform you if your benefits can be reinstated.
If you do not have the number to reach the eligibility worker, you can call the Social Services office in your area at the following numbers:
Benefit Desk: (510) 628-7698
Fremont: (510) 795-2428
Hayward: (510) 670-6000
Livermore: (925) 455-0747
East Oakland: (510) 639-1000
North Oakland: (510) 596-0110
What is the difference between a Medi-Cal hold on my benefits and a managed care
health plan hold?
Medi-Cal benefits are placed on hold by Social Services and the beneficiary isn't eligible for Medi-Cal or managed care health plan benefits. Managed Care benefits hold means the beneficiary may be eligible for "straight" or fee-for-service Medi-Cal, but is no longer eligible for health plan benefits.
My doctor does not speak my language, how can I communicate with him/her?
Many of our providers and their staff speak a variety of different languages; please refer to the Provider Directory to choose a provider in your area that speaks your language. The Alliance can also provide an interpreter to go with you to your medical appointments. If you need an interpreter, contact Alliance Member Services at (510) 747-4567. Please remember to call at least 3 business days prior to your appointment date.
I do not have transportation, how can I get to my doctor's appointments?
If you have Medi-Cal, you qualify for transportation benefits to medical appointments. Call Alliance Member Services at (510) 747-4567 at least 5 - 7 days before your scheduled appointment,for assistance . If you call the same day of your appointment, we cannot guarantee transportation.
Other plan members are entitled to transportation benefits only if it is medically necessary and authorized by the Alliance. An example of medically necessary transportation would be wheelchair transport, etc.
What do I do if I am temporarily out of the area and need medical services?
If you are temporarily out of Alameda County (such as on vacation), you are eligible to receive emergency services at any hospital. Show your Medi-Cal and the Alliance ID card to the hospital, so that they know whom to bill.
If you should need non-urgent care, you or your attending doctor should contact your the Alliance PCP and ask him/her to provide a referral for the attending doctor. The doctor in the other county may also call the Alliance Authorizations department for more information at (510) 747-4323.
I have moved out of Alameda County, can I still qualify for the Alliance benefits? If you have Medi-Cal and have moved out of Alameda County, you need to contact your eligibility technician at Social Services in Alameda County to inform Social Services that you have moved out of the area. Your eligibility technician will assist you with transferring your Medi-Cal benefits to your new county of residence. Make sure to give your eligibility technician your new address and phone number, the date you moved and the names of all of the family members on your case who have moved with you. Also contact Member Services to update your address and phone number.
The Alliance's network is in Alameda County, so if you go to a doctor outside of Alameda County who does not accept Medi-Cal, the doctor should contact the Alliance or your Alliance PCP for authorization for most services.
If you need urgent disenrollment because you have moved outside of Alameda County, you can contact Health Care Options (HCO) at 1-800-430-4263 with your move information. HCO can disenroll you from our health plan within 72 business hours.
If you need more information on disenrolling, please call Member Services.
If you have Healthy Families, you will be able to choose another health plan in your new county of residence. Contact the Healthy Families Program to let them know that you have moved.
If you have Group Care, you may continue your benefits if you still work as an IHSS worker in Alameda County and meet the eligibility requirements. IHSS/ Group Care Members must be working in Alameda County.
What should I do when I am sick or hurt?
When you are sick or hurt, you need help right away. To make sure you get the right help, follow these steps:
Call your Primary Care Provider (PCP). Your doctor can help tell you what to do.
In emergencies, Immediately go to the nearest emergency room if you are experiencing symptoms such as:
Seizures Poisoning Chest pain Broken bones Head injury Loss of consciousness with confusion or shockAn emergency is a sudden medical problem with severe symptoms that needs treatment right away.
I received a medical bill from my provider, what should I do?If you receive a bill from your provider, please contact the doctor to make sure they did not send the bill to you in error. Medi-Cal providers should send the bill directly to the Alliance for payment, but due to reasons such as not having the correct coverage information, they may not know where to bill.
If you cannot resolve the problem directly with the provider, please contact Member Services for instructions on how to send us the bill. We will need the following information:
The date of the medical service The doctor's/hospital name The amount of the bill A copy of the itemized bill Name and Alliance Member ID number of the Alliance member who received the service Once we receive the copy of the bill, we will review it to make sure you were eligible for the service. If you were eligible for the service, we will send the payment to the provider.
Note:
If you receive bills for the services below, please do not send them to the Alliance. These services are covered through other programs. Please contact the numbers listed below for payment information:
AFP ( Alpha Fetal Protein) screenings: Contact the Extended AFP Program at (510) 353-2000
Mental Health services: Contact ACCESS mental health at 1-800-491-9099
Children First Medical Group (CFMG) Provider services: Contact CFMG Claims Office at (510) 428-3478
Community Health Central Network (CHCN) Provider Services: Contact CHCN Claims Department at (510) 769-2210.
