Members' Frequently Asked Questions

1. Where do I apply for MSI Benefits?

2. How long is my MSI eligibility effective?

3. How will I know if I am approved for MSI benefits?

4. How long does the application process take?

5. What services does MSI cover?

6. Do I have to pay a portion of my heath care services?

7. How do I find a primary care physician?

8. May I change my PCP after I have been assigned?

9. How do I change my PCP?

10. Where do I obtain medical services if my PCP’s office is closed or I cannot get a timely appointment?

11. How do I obtain a physician specialist?

12. Where do I get my prescriptions filled?

13. Where do I go for lab work and other diagnostic procedures?

14. What do I do with the bills I receive from physicians, hospitals and other providers of service?

15. Am I responsible for payment if the MSI program refuses to pay a bill?

16. Are there other resources for health care if I am denied MSI benefits?

1. Where do I apply for MSI Benefits?

Applications are taken at MSI contracted hospitals and qualified community clinics. These facilities are listed in the MSI Member Handbook (on this website).

Note: The Member Handbook outlines all qualifications required to obtain MSI eligibility.

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2. How long is my MSI eligibility effective?

Eligibility is generally effective for twelve months. Members may reapply in their twelfth month of eligibility (only if a medical condition still exists). It is recommended that members call for an appointment early in their eleventh month of eligibility.

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3. How will I know if I am approved for MSI benefits?

Members are sent a document called, Notice of Action Letter (NOA). This letter informs the applicant of their eligibility status-approval or denial.

The approval NOA also has a tear-out Member ID card for convenience. It is important to present either the NOA letter or the card prior to receipt of service.

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4. How long does the application process take?

The application is reviewed by the MSI program’s Social Services Agency (SSA). This process takes approximately four-six weeks from the date of application. Questions about the status of an application should be referred to the SSA Eligibility Information Line at (866) 979-6772.

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5. What services does MSI cover?

A general overview of covered and non-covered benefits is available in the Member Handbook.

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6. Do I have to pay a portion of my heath care services?

MSI members are responsible to pay the following:

• Primary Care office visit: $5.00 (each visit)

• Specialist office visit: $5.00 (each visit)

• Prescriptions: $4.00 for each prescription (maximum of $32.00 per month)

• Emergency Room: $25.00 (each visit)

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7. How do I find a primary care physician?

All MSI members are required to have a Primary Care Physician (PCP) also known as a Medical Home.

Once eligibility is confirmed, Member’s should call the MSI program’s Patient Education Department (PED) at (800) 417-4262 Option 1 to request a PCP. The PCP is selected from a specific list of physicians in private practice, and community clinics.

Note: If you would like to continue with a physician you were assigned in a prior eligibility period, you may request the same assignment, provided the physician is still available.

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8. May I change my PCP after I have been assigned?

Members may change their PCP once within the first 30 days of their current eligibility and once every six months, thereafter.

Note: Services received from a PCP other than your assigned one, will result in a denial of payment.

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9. How do I change my PCP?

To change your PCP, call the MSI program’s Patient Education Department (PED) at 800-417-4262, option 1.

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10. Where do I obtain medical services if my PCP’s office is closed or I cannot get a timely appointment?

Urgent Care Centers and CVS Minute clinics are available for medical conditions that are not of a serious nature but require evaluation within a few days. A list of these facilities is available in the Member Handbook. Life or limb threatening conditions should be evaluated in the Emergency Department (ED); always access the closest ED in these situations.

Note: The MSI program’s Nurse Line at (877) 402-7111 is also available (24/7) to discuss a medical concern

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11. How do I obtain a physician specialist?

Requests for physician specialty services must be coordinated through the member’s PCP, and are approved by the MSI program’s Authorization Department. Refer to the Member Handbook for additional information on this process.

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12. Where do I get my prescriptions filled?

Prescriptions must be filled at participating Rxamerica/CVS-Caremark pharmacies. Ask your local pharmacist if the pharmacy is a participant.

Note: Refer to the Member Handbook for information about the MSI Drug Formulary.

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13. Where do I go for lab work and other diagnostic procedures?

Laboratory services are provided through Quest diagnostics; for a list of service locations call (800) 377-8448. All other diagnostic services including, MRI, CT scan, PET scan, ultrasound and general X-ray must be provided through MSI contracted facilities (a list of these locations is available in the Member Handbook under Outpatient services).

Note: All diagnostic services must have a written order from a physician, nurse practitioner or physician assistant.

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14. What do I do with the bills I receive from physicians, hospitals and other providers of service?

Providers of service often bill members because they are not aware of the member’s MSI eligibility. It is the member’s responsibility to inform all providers of their MSI eligibility status. It is a good idea to photocopy the NOA letter, and send a copy to each provider.

Providers must bill the MSI program within 90 days of the date the service was received or 90 days from the date on the NOA letter, whichever, is later.

Note: Members may be responsible for payment if they fail to notify providers of their MSI eligibility status

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15. Am I responsible for payment if the MSI program refuses to pay a bill?

The MSI program does not guarantee payment for all services. Members may be responsible to pay providers, if the Program does not make payment.

Note: There is an appeal process for a denial of payment. This process is outlined in detail, in the MSI Member Handbook

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16. Are there other resources for health care if I am denied MSI benefits?

There are several resources that may be able to assist with health care and other important needs:

• Public Health referral line: (800) 564-8448. Provides referrals for medical needs including, immunizations, birth control, pregnancy tests, family planning and child health care.

• General relief and Food Stamps: (714) 834-8899.

• 211 Orange County: Provides resources for shelter, food and clothing.

• Partnership for Prescription Assistance: (888) 477-2669. Provides information about programs that may provide medications at low or no cost

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