Provider Alerts - November 13, 2018

HPSJ Expedites Access to Benefits & Prescriptions for Any HPSJ Medi-Cal Member Affected by California Wildfires & Smoke


Date: November 13, 2018
To: HPSJ Providers, HPSJ Pharmacies, Community-Based Organizations – San Joaquin & Stanislaus Counties
From: Health Plan of San Joaquin, External Affairs
Subject: HPSJ Expedites Access to Benefits & Prescriptions for Any HPSJ Medi-Cal Member Affected by California Wildfires & Smoke

Health Plan of San Joaquin (HPSJ) has set up streamlined access to benefits and prescriptions for any of its members who may be impacted by the fires now raging in Butte, Los Angeles, and Ventura counties. HPSJ is reaching out to our Members who may be in impacted areas.

Community-Based Organizations (CBOs):
Because many of our members are served by CBOs throughout San Joaquin and Stanislaus counties, we wanted you to be aware of this initiative. Please assist in spreading the word.

Since Governor Brown has declared a state of emergency, HPSJ is taking these steps so that our members who may be impacted by these disasters are able to have ready access to medical services and prescriptions that they might need. While the majority of people served by our programs reside in San Joaquin and Stanislaus counties, there are members who are traveling beyond their home community, as well as dependents who may be out of area, and are in one of the fire-impacted areas.

The two counties of HPSJ’s licensed service area (San Joaquin and Stanislaus counties) are not currently in the path of any of these fires.

For affected members served by HPSJ, the assistance provided will include: The following items are required:

  • Ease of Access to Medications and Prescriptions
    • HPSJ is contracted with nearly all pharmacies in California, including all major chains. Members may go to any of these pharmacies. In the rare instance that a pharmacy is not part of the network, HPSJ will reimburse the member for out of pocket charges.
    • If members have had their prescriptions lost, damaged or destroyed due to fire or mandated evacuations, they may immediately refill them, even if they are not due to be refilled.
    • HPSJ offers a three-day supply for medications, including controlled medications that are part of a benefit, but may be subject to restrictions.
  • Provider Access
    • Members unable to be seen by their network or customary providers, including urgent care and hospitals, will be assisted in identifying alternative providers, including, if necessary, out-of-network physicians.
  • Mental Health
    • HPSJ’s partner, Beacon Health Strategies, will help members find mental health help if they cannot reach their usual source of care.
  • Urgent Care
    • If the fires cause members to need urgent care, they may go out of HPSJ’s network; if they have to pay for this, they will be reimbursed.
  • Toll-free numbers for questions including loss of member ID card, access to prescription refills and appropriate out-of-network providers, or how to access nearby health care:
    • HPSJ Customer Service number, at 888-936-7526 (711 for hearing impaired members)
    • HealthReach 24/7 Nurse Advice Line, at 1-800-655-8294

If you have any further questions regarding this situation – including about prior authorizations, pre-certifications, or referrals, or regarding replacements of members’ medical equipment or supplies, as well as any other related matter – please contact our Customer Services Department at (209) 942-6320.

We also are concerned about the health effects of smoke from the wildfires. Following please find the “CalFires Wildfires Smoke Fact Sheet” for more information.