Non-Covered Benefits

🎗️ IMPORTANT PATIENT NOTICE

📋 Non-Covered Benefits for External Referrals

Not all referrals are automatically covered by your health insurance plan.

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❌ What Are Non-Covered Benefits?

Some services or specialists requested through an external referral may not be included in your health insurance, Medi-Cal, or Medicare plan. These are called non-covered benefits.

That means:
• The health plan may deny authorization
• You may have to pay out-of-pocket
• Or the service may not be available at all under your plan

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🔍 Common Reasons Services May Not Be Covered:

✔️ The service is not considered medically necessary
✔️ The provider or facility is out of network
✔️ You do not have a referral requirement in your plan
✔️ The service is not part of your plan’s covered benefits

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🧾 What Happens If My Referral Is Not Covered?

If your referral is denied as a non-covered benefit, you will receive:
📬 A letter from your health plan explaining the denial

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🛠️ What Are My Options?

If denied, you can:

  1. Appeal the decision with your health plan

  2. Speak to your primary care provider about alternatives

  3. Explore low-cost or sliding scale options, if available

  4. Pay out-of-pocket if you still want the service

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💬 Need Help Understanding a Denial?

We’re here to help!
📞 Call the Referral Department: (213) 588-1323
🕘 Hours: Mon–Fri 8:30AM–5:00PM | Sat 7:00AM–3:30PM

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🔑 Tips to Avoid Delays:

✔ Make sure your contact info is up to date with your health plan
✔ Respond quickly to any letters or calls
✔ Check with your health plan if you’re unsure what’s covered