Join us as we Go Green.* Have easy access to your important health materials and help us improve our environment by getting your annual and welcome member materials online instead of through the mail.

We are here to help

You can request these materials in paper form at any time. We will send the materials to you within 7-10 business days of your request. If you would like to receive member materials in another language, we can help.

For more information, or to request any materials in paper form, please complete our online Contact Us Form or send us a secure message by logging into your online Alliance Member Portal.

You can also call:

*You will still receive other important member health information and letters by mail.

Group Care Member Materials

To view and download your Alliance member materials, please select your preferred language.

Welcome Alliance Group Care Member Materials

As a new Alliance Group Care member, we created handouts for you to learn more about your health plan, and your benefits and covered services.

Welcome Letter
English | Spanish | Chinese

Advice Nurse Line Flyer
English | Spanish | Chinese

Alliance Group Care Member Handbook – Combined Evidence of Coverage (EOC) and Disclosure Form
English | Spanish | Chinese

Alliance Group Care Provider Directory (all languages)

No Cost Alzheimer’s Training Program
English | Spanish | Chinese

Alliance Interpreter Services
Alliance Interpreter Services

California Immunization Registry (CAIR) Letter
English | Spanish | Chinese

Emergency Room (ER) Flyer
English | Spanish | Chinese

Member Portal Flyer
English | Spanish | Chinese

Nondiscrimination Notice
English | Spanish | Chinese

PG&E Public Safety Power Shutoff (PSPS) Program
English | Spanish | Chinese

Summary of Benefits and Glossary
English | Spanish | Chinese

Your Health Care Checklist
English | Spanish | Chinese

Your Primary Care Provider (PCP) Is Important
English | Spanish | Chinese

Wellness Programs and Materials Request Form
English | Spanish | Chinese

Member Handbook

We want you to get the most out of your health plan. Your Alliance Group Care Member Handbook also known as the Combined Evidence of Coverage (EOC) and Disclosure Form is mailed to our members annually.
English | Spanish | Chinese

Provider Directory

To view a copy of the Alliance Provider Directory for Group Care members, please click here.

You can also search for a provider in our online Alliance Provider Directory.

Group Care Benefits and Covered Services

Authorization Process for Covered Group Care Benefits and Services

Pre-approval (prior authorization) For some types of care, your PCP or specialist will need to ask the Alliance for permission before you get the care. This is called asking for prior authorization, prior approval, or preapproval. It means that the Alliance must make sure that the care is medically necessary or needed. Medically necessary services are reasonable and necessary to protect your life, keep you from becoming seriously ill or disabled, or reduce severe pain from a diagnosed disease, illness or injury. For members under the age of 21, Medi-Cal services includes care that is medically necessary to fix or help relieve a physical or mental illness or condition.

The following services always need pre-approval (prior authorization), even if you get them from a provider in the Alliance network:

  • Hospitalization, if not an emergency
  • Services out of the Alliance service area, if not an emergency or urgent
  • Outpatient surgery • Long-term care at a nursing facility
  • Specialized treatments
  • Medical transportation services when it is not an emergency. Emergency ambulance services do not require pre-approval.
  • Outpatient diagnostic and radiology services, minimally invasive or invasive, such as CT scans, MRIs, cardiac catheterization, PET
  • Home Health Care, including skilled nursing, nursing aides, rehabilitation therapies, and social workers

Under Health and Safety Code Section 1367.01(h)(1), the Alliance will decide routine preapprovals (prior authorizations) within five (5) working days of when the Alliance gets the information reasonably needed to decide.

For requests in which a provider indicates or the Alliance determines that following the standard time frame could seriously endanger your life or health or ability to attain, maintain, or regain maximum function, the Alliance will make an expedited (fast) preapproval (prior authorization) decision. The Alliance will give you notice as quickly as your health condition requires and no later than 72 hours after getting the request for services.

Pre-approval (prior authorization) requests are reviewed by clinical or medical staff, such as doctors, nurses and pharmacists. The Alliance does not pay the reviewers to deny coverage or services. If the Alliance does not approve the request, the Alliance will send you a Notice of Action (NOA) letter. The NOA letter will tell you how to file an appeal if you do not agree with the decision. The Alliance will contact you if the Alliance needs more information or more time to review your request.

You never need pre-approval (prior authorization) for emergency care, even if it is out of the network and out of your service area. This includes labor and delivery if you are pregnant.

You do not need pre-approval (prior authorization) for sensitive services, such as family planning, HIV/AIDS services, and outpatient abortions. For questions about pre-approval (prior authorization), call:

Pre-Service Authorizations

The Alliance Utilization Management (UM) Department must review and approve some types of care before they are provided. Your primary care provider (PCP) or specialist will work with the Alliance UM to get pre-service authorizations. The Alliance UM clinical review team of doctors determine whether the service is clinically appropriate, performed in the appropriate setting, and a part of your covered benefits.

Your PCP or specialist will give the Alliance UM team the clinical information that is needed for all services that require a medical necessity review. Your PCP or specialist must select the “Type of Request” on the Prior Authorization (PA) Request Form.

Your PCP or specialist must also include all supporting clinical information with the initial request to help ensure a timely decision. If the clinical review information is not received with the PA Request Form, the Alliance UM team will contact your PCP or specialist to collect the needed information.

Clinical information about a member may include:

  • Consultations
  • Diagnostic results
  • History of presenting problem
  • Member’s response to treatment
  • Photographs
  • Physical assessment
  • Previous and current treatment

 

Your PCP or specialist should provide clinical information at least five (5) days prior to the planned service date to ensure timely notification of coverage approval. Your PCP or specialist is responsible for obtaining authorization. Your PCP or specialist must provide an authorization reference number on all referrals and claims.

Prior Authorization Request – Determination Turnaround Times
Non-Urgent Requests Within five (5) business days of receipt.
Urgent Requests Within 72 hours of receipt.
Urgent Concurrent Decisions Within 24 hours of notification, if clinical is available; 72 hours if clinical is requested.
Post-Service Decisions Considered if submitted within 30 days of date of service.

Post-Service/Retrospective Review

The Alliance post-service retrospective review is the process that the Alliance Utilization Management (UM) team works with your PCP or specialist to determine medical necessity or coverage under the health plan benefit. Post-service retrospective authorizations will only be considered if submitted within 30 days of the date of service.

After-Hours Care

At the Alliance, we are here to help. As your partner in health, we strive to connect you to the right care at the right time. If you have a health concern, please call your doctor any time, 24 hours a day, 7 days a week.

Your Doctor

Call your doctor’s office or clinic for advice. Doctors expect to get phone calls at night or on weekends. They set up their practices to receive your calls at times when they are not open. Your doctor can help you decide if you really need to go to the emergency room, or can give you advice about what to do at home that can get you or your child through the night or weekend.

Advice Nurse Line

If you can’t reach your doctor, the nurse line is ready to give you advice, any time, 24 hours a day, 7 days a week.
Please call:

Toll-Free: 1.855.383.7873

Key features of the Advice Nurse Line:

  • No cost for Alliance Members.
  • Ready to help 24 hours a day, 7 days a week.
  • Nurses provide advice on topics, such as:
    • Treatment of common health concerns
    • Tips on leading a healthy lifestyle
    • Health screenings and shots
  • Nurses help you decide whether you require emergency or urgent care, or if you should schedule a doctor’s visit.
  • Nurses speak English and Spanish, and use interpreters for other languages.
  • For more information, please select your preferred language:
    English | Spanish | Chinese

Urgent Care

Your doctor or the advice nurse line may direct you to an urgent care clinic. Many clinics are open late, on weekends and holidays. To find an urgent care clinic in the Alliance network, please search our online Alliance Provider Directory.

To view a copy of the Alliance Group Care Provider Directory, please click here.

Behavioral Health Care Services

As an Alliance member, you have access to behavioral health care services. These services are offered through our delegated provider, Beacon Health Options. Prior authorization (approval) is not required for routine outpatient behavioral health care services. The Alliance also covers all substance use disorder (SUD) services.

To find a behavioral health care provider in our network, or make an appointment, please contact:

Beacon Health Options
Toll-Free: 1.855.856.0577
www.beaconhealthoptions.com

    1. Click on Find a Provider.
    2. Select your plan type:
      • Alameda – IHSS – Group Care/In Home Support Services
      • Alameda – MediCal
    3. Enter your address.

Inpatient Behavioral Health Care and SUD Services

These are services ordered and performed by Beacon Health Options for the treatment of an acute phase of a behavioral health and/or SUD condition during a certified confinement in a hospital in the Alliance network.

Benefits include:

  • Behavioral Health Crisis Residential Treatment Programs (CRTPs).
  • Behavioral health psychiatric hospitalization.
  • SUD inpatient detoxification, as medically appropriate to remove toxic substances from the system.
  • SUD inpatient services.

Outpatient Behavioral Health Care and SUD Services

These are services used to provide crisis intervention and treatment of alcoholism, drug abuse, or behavioral health on an outpatient basis as medical appropriate.

Office visit benefits include:

  • Behavioral health individual and group evaluation and treatment.
  • Outpatient monitoring of drug therapy.
  • Psychiatric testing/observation.
  • Psychological testing.
  • SUD individual and group chemical dependency counseling.
  • SUD individual and group evaluation and treatment.

Other benefits include:

  • Behavioral health multidisciplinary treatment (intensive outpatient psychiatric treatment program).
  • Behavioral health treatment for PDD/Autism.
  • Opioid replacement therapy.
  • SUD intensive outpatient program.
  • SUD medication treatment for withdrawal.

To learn more about your benefits and covered services, please view your Alliance Group Care Member Handbook.

Dental Care

As an Alliance Group Care member, dental benefits are provided through Alameda County Public Authority for IHSS.
For more information, please contact:

Alameda County Public Authority for IHSS
Phone Number: 1.510.577.3552
ac-pa4ihss.org


To learn more about your benefits and covered services, please view your Alliance Group Care Member Handbook.

Durable Medical Equipment (DME)

As an Alliance Group Care member, the Alliance covers medical equipment appropriate for use in the home that:

  • Is intended for repeated use.
  • Is generally not useful to a person in the absence of illness or injury.
  • Primarily serves a medical purpose.

To learn more about your benefits and covered services, please view your Alliance Group Care Member Handbook.

Eye Care

As an Alliance Group Care member, eye benefits are provided through Alameda County Public Authority for IHSS.

For more information, please contact:

Alameda County Public Authority for IHSS
Phone Number: 1.510.577.3552
ac-pa4ihss.org


To learn more about your benefits and covered services, please view your Alliance Group Care Member Handbook.

Language & Interpreter Services

At the Alliance we want to help you receive your health care services in your preferred language.

Interpreter Services

When you call the Alliance, please let us know the language that you prefer to speak. Our staff speaks many languages, including Spanish, Cantonese, Vietnamese, and Tagalog. If we cannot speak your language, we will use a phone interpreter at no cost to you.

We can also help you speak with your Alliance health care providers in your preferred language. You can choose a doctor or clinic that speaks your preferred language. Or, we can provide a qualified health care interpreter over the phone or in person for your health care visits.  If you need an in-person interpreter, you must make the request at least five (5) business days in advance (except for American Sign Language).

To request an interpreter, please call the Alliance Member Services Department.

Members as well as doctors can request interpreter services. If you are a provider, please click here.

Member Materials

You may receive written plan letters and materials in a language that you can read. If you are not getting materials in your preferred language, please let us know. You may also receive member materials in other formats such as large print, audio, and accessible electronic formats at your request.

Keep Us Informed

In order to better serve you, it helps us to know your ethnicity and the preferred language that you speak and read.

You can view and update your information through our online Alliance Member Portal.

Do you need to create an Alliance Member Portal account? We can help!

Make a Request

To request a language interpreter  or materials in your preferred language, please complete our online Contact Us Form or call:

Transportation Services

Medical transportation services are offered by the Alliance at no cost. There are two (2) types of medical transportation services that are covered under Alliance Group Care.

Emergency Ambulance Services

The Alliance covers ambulance services to help you get to the nearest place of care in emergency situations. This means that your condition is serious enough that other ways of getting to a place of care could risk your health or life. This includes ambulance transportation services provided through the “911” emergency response system.

Authorized Ambulance Services

Ambulance services to transfer a member to or from a participating hospital or skilled nursing facility in connection with an authorized confinement/admission will be authorized only when transportation by other means would adversely affect the member’s medical condition, whether or not such other means of transportation are available.


To learn more about your benefits and covered services, please view your Alliance Group Care Member Handbook.

We Are Here to Help You

If you have any questions about your benefits and covered services, please call:

To send us a secure message, please complete our online Contact Us Form or log in to your online Alliance Member Portal.