The Evidence of Coverage (EOC) booklet also has a list of the kinds of services HPSJ covers. There are no copayments for these covered services. Your financial responsibility is $0 for these covered services. Practitioners, providers or other parties cannot and should not bill you for these covered services. You may get a medical bill if you go to a doctor that does not work with HPSJ or is located outside of HPSJ Service Area. If this happens, then you may be billed by the doctor and you may have to pay for services that are not covered by HPSJ. See Section 4 of the EOC, How Do I Get Care When I Need It.
Because you also get Medi-Cal, you may be able to get other services HPSJ does not cover but you may have to use the Medi-Cal fee-for-service program to get those services. See Section 6 of the EOC, Your Medi-Cal Benefits Not Covered by HPSJ.
Remember: Except for emergency or urgent care services, HPSJ covers only services and supplies that you need and that are provided, prescribed or authorized by your PCP, and, if necessary, approved by HPSJ. If you disagree with what is covered, see Section 2 of the EOC, Members Rights and Responsibilities.
If you have a question about what is covered, call Customer Service at: (209) 942-6320, or 1-888-936-PLAN (7526), toll-free (209) 942-6306 (TDD) Monday – Friday, 8:00 a.m. to 6:00 p.m.