Find a Doctor

A primary care provider or PCP is a health care professional or clinic that provides medical care. You will need to pick one doctor to see for all your health care needs. Depending on your age and gender, your doctor can be a:

• General practitioner.
• Internist.
• Pediatrician.
• Family practitioner.
• Ob/Gyn.
• Nurse practitioner.
• Physician assistant.
• Clinic.

You can also choose a Federally Qualified Health Center (FQHC) or a Rural Health Clinic (RHC) as your doctor These health centers are in areas that do not have many health care services.

You must pick a doctor within 30 days of enrolling with the Alliance. If you do not, we will assign you a doctor. To find a doctor near you, go to the online Provider Directory or call Member Services. We are here to help.

You should see your doctor for a new patient exam within 120 days (4 months) of becoming an Alliance member.

Call or make an appointment to see your doctor first when you need medical care. Your doctor can do many things for you, such as:

• Guide all of your health care.
• Give you regular check-ups, immunizations and help when you are sick.
• Help prevent health problems or manage chronic health issues, like diabetes.
• Refer you to other doctors when you need it.

Over time, your PCP will get to know your health history and help you make good choices so you can stay well.

If you are having a medical emergency, call 911 or go to the nearest emergency room.

Use the Provider Directory to find a doctor and pick your primary care provider (PCP). You may need a referral from your PCP before making an appointment with a specialist for non-emergency care. Call your PCP to find out if you need a referral.

There are three ways to look for a provider:

1. Search the online Provider Directory.
   View the online Provider Directory. 
   • Make sure to select your plan in the Health Plan drop-down menu.
   • Choose a provider type.
   • Check the box for “Accepting New Patients."

   For more information on how to use the online Provider Directory, view our online Provider Directory Tutorial.

2. Download the Provider Directory.
   Download the Provider Directory for your county.
   • Medi-Cal: Monterey and Santa Cruz counties (English and Spanish)
   • Medi-Cal: Mariposa and Merced County (English, Spanish and Hmong)
   • Medi-Cal: San Benito County (English and Spanish)
3. Get a printed directory mailed to you.
   If you would like a printed copy of the provider directory, use the online self-service form to ask for one. You can also call Member Services and ask them to mail one to you. To find a doctor in the printed Provider Directory:

• Locate the Primary Care Provider section in the Table of Contents.
• Choose a town that is close to you and go to the page number listed for that town.
• Make sure the doctor or clinic is accepting new patients. Above the wheelchair picture is a line that says Accepting Patients. If there is a Y that means that new patients are allowed.

Once you have found a doctor, fill out the Choose or Change Primary Doctor form online. You can also call Alliance Member Services.

If the doctor or clinic is taking new patients, you will get an updated Alliance Member ID card.

To change your doctor, call Member Services. You can also fill out the Choose Primary Doctor form. The change will be in effect on the first day of the next month.

Call your doctor’s office to make an appointment with your doctor.

View tips on how to prepare for your doctor visit.

If your current PCP is not in the Alliance network, you may still be able to keep seeing them for a specific time period. This is called continuity of care. Read the chart below for some reasons you can keep seeing your out-of-network doctor, and for how long you can see them.

Your out-of-network doctor must accept the same terms and conditions that Alliance providers agree to. Your doctor must also meet the Alliance’s applicable professional standards and have no disqualifying quality of care issues.

If your doctor does not join the Alliance network by the end of 12 months, does not agree to the Alliance’s payment rates, or does not meet quality of care requirements, you will need to switch to a doctor in the Alliance network.

What if I had to change my health plan or switch from Fee-for-Service Medi-Cal into managed care?

If you were required to change your health plan or to switch from FFS to managed care, or you had a provider who was in network but is now outside the network, you might be able to keep your provider even if they are not in the Alliance network under continuity of care.

If you need to get care from a provider who is outside the network, call the Alliance to ask for continuity of care. You may be able to get continuity of care for up to 12 months or more if all of the following are true:

•  You have an ongoing relationship with the out-of-network provider before enrollment in the Alliance.
•  You went to the out-of-network provider for a non-emergency visit at least once during the 12 months before your enrollment with the Alliance.
• The out-of-network provider is willing to work with the Alliance and agrees to the Alliance’s contract requirements and payment for services.
•  The out-of-network provider meets the Alliance’s professional standards.
• The out-of-network provider is enrolled and participating in the Medi-Cal program.

To learn more, call Member Services at 800-700-3874 (TTY 800-735-2929 or 711).

To learn more about continuity of care, eligibility and services, contact Member Services at 800-700-3874, Monday through Friday from 8 a.m. to 5:30 p.m. If you need language assistance, we have a special telephone line to get an interpreter who speaks your language at no cost to you. For the Hearing or Speech Assistance Line, call 800-735-2929 (TTY: Dial 711).