January 16, 2024
The California Medical Association (CMA) has learned that the contract between L.A. Care Health Plan and Heritage Provider Network (Regal Medical Group, Lakeside Community Healthcare, High Desert Medical Group, and Sierra Medical Group) has terminated effective December 31, 2023, affecting approximately 44,000, enrollees throughout Los Angeles.
L.A. Care Health Plan enrollees impacted by the termination have been reassigned to other delegated groups in the L.A. Care network based on their primary care physician and time and distance standards from the enrollee’s home.
Patients may in certain circumstances be able to continue to see their physicians under California’s continuity of care laws. These laws allow patients to request continuity of care for ongoing treatment of an acute condition, serious chronic condition, pregnancy or terminal illness. Continuity of care can also be requested for children between birth and 36 months, and for the performance of a surgery or other procedure that has already been authorized. To request continuity of care, patients should call the number on the back of their health plan ID card.
For more information on continuity of care requirements, see CMA health law library document #7051, “Contract Termination By Physicians and Continuity of Care Provisions.”
Physicians are strongly encouraged to obtain any updated insurance information and verify eligibility when seeing a patient. Eligibility can be verified on the L.A. Care IVR Provider Portal, through the Medi-Cal Provider Portal or the Automated Eligibility Verification System.
Physicians with questions can contact the L.A. Care Provider Service Call Center at (866) 522-2736.