Appointments and Referrals

Medi-Cal members requesting an appointment with their primary care physician (PCP) must be scheduled for an appointment within 10 business days if the child is behind schedule for a preventive, well-child screening exam. If the PCP cannot provide the needed services within 10 business days, the PCP may refer the member to another participating provider, out-of-network  well-child screening services provider, local health department, or school-based well-child screening services program. A PCP referring a member to an out-of-network provider must furnish a complete referral. 

If an external source (for example, school, member or out-of-network provider) contacts the Health Net Medi-Cal Member Services Department, Community Health Plan of Imperial Valley Member Services Department or CalViva Health Medi-Cal Member Services Department (for Fresno, Kings and Madera counties), a representative makes contact with the member's PCP to determine whether the member is in need of current preventive, well-child screening services and to provide assistance with appointment scheduling as needed.