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Insurance Plans - California
Select the name of your insurance company to find out where to get forms
and to find contact information for your plan if you need to request prior
authorization or an exception.
This information was collected from the Web sites of the plans, and in
some cases from e-mails and phone calls to the plans. It is provided here
in an effort to make the information more conveniently available to you.
We do not endorse any particular plan and we are not responsible if any
plan has been inadvertently omitted from this list. We have not verified
this information. In addition, we cannot be responsible for ensuring that
the information is always up to date. Please notify
us if you are aware that any of the information provided has changed.
If you would like more detailed and current information, we suggest that
you consult the Medicare
Web site.
AETNA HEALTH INC
AIDS HEALTHCARE FOUNDATION
ANTHEM HEALTH PLANS OF KENTUCKY, INC.
BC LIFE & HEALTH INSURANCE COMPANY
Where to Get Forms: http://www.anthemprescription.com
Phone # to request Prior Authorization: 1-800-338-6180
Phone # to request Exception: 1-800-338-6180
Fax #: 1-800-601-4829
E-mail Address: Not Available Updated: May 2006
BLUE CROSS OF CALIFORNIA
Where to Get Forms: http://www.anthemprescription.com
Phone # to request Prior Authorization: 1-800-338-6180
Phone # to request Exception: 1-800-338-6180
Fax #: 1-800-601-4829
E-mail Address: Not Available Updated: May 2006
CA PHYSICIANS SERV/DBA BLUE SHIELD OF CALIF
CALIFORNIA HEALTH PLAN
Where to Get Forms: Not Available
Phone # to request Prior Authorization: 1-800-546-5677 x32
Phone # to request Exception: 1-800-546-5677 x32
Fax #: 1-800-458-1646
E-mail Address: eschram@pti-nps.com Updated: May 2006
CENTRAL HEALTH PLAN OF CALIFORNIA, INC.
Where to Get Forms: Call 1-800-788-2949 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-788-2949 Option 3
Phone # to request Exception: 1-800-788-2949 Option 3
Fax #: 858-790-7100
E-mail Address: customerservice@medimpact.com Updated: May 2006
CHINESE COMMUNITY HEALTH PLAN
Where to Get Forms: Call 1-877-665-6609 and ask to have form faxed.
Phone # to request Prior Authorization: 1-877-665-6609
Phone # to request Exception: 1-800-207-2568
Fax #: 1-866-617-6685
E-mail Address: medicaredhpms@express-scripts.com Updated: May 2006
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
COVENTRY HEALTH AND LIFE INS COMPANY
Where to Get Forms: Call 1-800-551-2694 and ask to have form faxed.
Phone # to request Prior Authorization: 1-800-551-2694
Phone # to request Exception: 1-800-551-2694
Fax #: Call 1-800-551-2694 and ask for fax number.
E-mail Address: Not Available
Updated: May 2006
FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY
Where to Get Forms: Call 1-800-551-2694 and ask to have form faxed.
Phone # to request Prior Authorization: 1-800-551-2694
Phone # to request Exception: 1-800-551-2694
Fax #: Call 1-800-551-2694 and ask for fax number.
E-mail Address: Not Available
Updated: May 2006
HEALTH NET LIFE INS CO/HEALTH NET INS OF NY
HONORED CITIZENS CHOICE HEALTH PLAN INC
Where to Get Forms: Not Available
Phone # to request Prior Authorization: 1-800-872-8276 (ask for customer service)
Phone # to request Exception: 1-800-872-8276 (ask for customer service)
Fax #: Call 1-800-872-8276 and ask for fax number.
E-mail Address: j.sweeney@americanhealthcare.com Updated: May 2006
HUMANA HEALTH PLAN, INC.
INTER VALLEY HEALTH PLAN, INC.
KAISER FOUNDATION HP
Where to Get Forms: Call 1-877-645-1282 and ask for assistance.
Phone # to request Prior Authorization: Not Available
Phone # to request Exception: 1-877-645-1282
Fax #: Not Available
E-mail Address: janice.m.regan@kp.org Updated: May 2006
MARQUETTE NATIONAL LIFE INSURANCE COMPANY
Where to Get Forms: Call 1-800-244-5800 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-244-5800
Phone # to request Exception: 1-800-244-5800
Fax #: 513-881-6841
E-mail Address: JRoesch@pharmacare.com Updated: May 2006
MEDCO CONTAINMENT INSURANCE COMPANY OF NEW YORK
Where to Get Forms: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Prior Authorization: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Exception: Not Available
Fax #: Not Available
E-mail Address: Not Available
Updated: May 2006
MEDCORE HP
Where to Get Forms: Call 1-877-665-6609 and ask to have form faxed.
Phone # to request Prior Authorization: 1-877-665-6609
Phone # to request Exception: 1-800-207-2568
Fax #: 1-866-617-6685
E-mail Address: medicaredhpms@express-scripts.com Updated: May 2006
MEMBERHEALTH, INC.
MOLINA HEALTHCARE OF CALIFORNIA
Where to Get Forms:
Call 1-866-772-7737 for fax on demand automated phone service.
Phone # to request Prior Authorization: 1-866-549-0991
Phone # to request Exception: 1-866-549-0991
Fax #: 1-866-855-2676
E-mail Address: reed.evans@rxamerica.com Updated: May 2006
ORANGE COUNTY HEALTH AUTHORITY
PACIFICARE LIFE AND HEALTH
INSURANCE COMPANY
PENNSYLVANIA LIFE INSURANCE
COMPANY
Where to Get Forms:
Call 1-800-244-5800 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-244-5800
Phone # to request Exception: 1-800-244-5800
Fax #: 513-881-6841
E-mail Address: JRoesch@pharmacare.com
Updated: May 2006
RXAMERICA, LLC
Where to Get Forms:
Call 1-866-772-7737 for fax on demand automated phone service.
Phone # to request Prior Authorization: 1-866-549-0991
Phone # to request Exception: 1-866-549-0991
Fax #: 1-866-855-2676
E-mail Address: lois.mastin@rxamerica.com
Updated: May 2006
SAN MATEO HEALTH COMMISSION
Where to Get Forms:
Call 1-800-788-2949 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-788-2949 Option 3
Phone # to request Exception: 1-800-788-2949 Option 3
Fax #: 858-790-7100
E-mail Address: customerservice@medimpact.com
Updated: May 2006
SCAN HEALTH PLAN
Where to Get Forms:
Call 1-877-665-6609 and ask to have form faxed.
Phone # to request Prior Authorization: 1-877-665-6609
Phone # to request Exception: 1-800-207-2568
Fax #: 1-866-617-6685
E-mail Address: medicaredhpms@express-scripts.com
Updated: May 2006
SIERRA HEALTH AND LIFE INSURANCE
COMPANY, INC.
SILVERSCRIPT INSURANCE COMPANY
SUTTER HEALTH SACRAMENTO
SIERRA REGION
Where to Get Forms:
Not Available
Phone # to request Prior Authorization: Not Available
Phone # to request Exception: Not Available
Fax #: 916-446-3699
E-mail Address: ThornbC@sutterhealth.org
Updated: May 2006
UHP HEALTHCARE
UNICARE
UNITED AMERICAN INSURANCE
COMPANY
Where to Get Forms:
Your pharmacist will receive information from the plan if your prescription
is denied because of a coverage problem.
Phone # to request Prior Authorization: Your pharmacist will receive
information from the plan if your prescription is denied because of a
coverage problem.
Phone # to request Exception: Not Available
Fax #: Not Available
E-mail Address: pharmcontracting@medco.com
Updated: May 2006
UNITED HEALTHCARE INSURANCE
COMPANY
Where to Get Forms:
Call 1-877-665-6614 and ask to have form faxed.
Phone # to request Prior Authorization: 1-877-665-6614
Phone # to request Exception: 1-800-207-2573
Fax #: 1-866-617-6690
E-mail Address: provider.relations@walgreens.com
Updated: May 2006
UNIVERSAL CARE
Where to Get Forms:
Call 1-800-788-2949 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-788-2949 Option 3
Phone # to request Exception: 1-800-788-2949 Option 3
Fax #: 858-790-7100
E-mail Address: customerservice@medimpact.com
Updated: May 2006
WELLCARE HEALTH PLANS
WESTERN HEALTH ADVANTAGE
Where to Get Forms:
Your pharmacist will receive information from the plan if your prescription
is denied because of a coverage problem.
Phone # to request Prior Authorization: Your pharmacist will receive
information from the plan if your prescription is denied because of a
coverage problem.
Phone # to request Exception: Not Available
Fax #: Not Available
E-mail Address: pharmcontracting@medco.com
Updated: May 2006
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