Update 8-10-26 still no call back from Supervisor or anyone there. These people only care about a small part of patient care and if it goes outside the perimeters, "it's not my job". read more

Great experience, always with good attitude and they explain everything perfectly. Their service is very professional.

Since Saddleback medical group joined CalOptima you can no longer contact your Dr. without going through an unhelpful gatekeeper. Terrible system more time consuming and frustrating. read more

I had a wonderful experience with their service overall. I'm especially happy with the newest person joining my healthcare team. The scheduling and administrative communication were fair, and the therapy was good. The care quality with the provider was also good. read more

Runaround on Gender Affirming Care "We support transgender patients" "We're allies" Horse puckey. They REQUIRED me to waste my time by seeing my PCP for a referral, which will apparently take a month to be authorized. There was ZERO reason for me to see my Doctor. NONE. It was a complete waste of everyone's time. So now I have to wait to see an endocrinologist, but get this: not a single one in my network is LGBTQ friendly. I am discouraged and disgusted. For all their talk about support, they sure as heck don't show it with this nonsense. Supposedly they have a gender affirming program. The program can be described thusly: "screw over trans people with our unnecessary steps to receive care. They'll just give up, which will save us money." And no matter what they tell you, that is EXACTLY what they are doing. I'll be reporting this to medi-cal. read more

Type of care? None. Care quality? Not applicable. Office experience? NA. What can you improve? You tell me. It's a classic oversell by Alexes. Typically comes with under-delivery, right? Nope. This one is zero delivery. Zilch. Nada. No response from PCP, Dr. Winston Wong of La Palma. No response from my "care coordinator" Han? Aka Kathy? Omg. If there's a negative 100 stars, that's what you get. And I left OC PACE for this? 12 days of nothing. Today is the 12th. Open enrollment is the 15th. I'm switching from CalOptima OneCare Complete. It's actually now called CalOptima OneCare INCOMPLETE! read more

They out source to sub par companies that just wanted to scam the elderly. Caloptima must be ok or get kicked backs from these companies that they bill the insurance for useless procedures. I was supposed to talk with nutritionist but only talked with a very young girl who was reading from a script or a man was telling her what to say because I could hear him. This is a scam. read more

i wish i can give this place 0 stars. so slow. so much attitude. worse insurance place you can go with. do not come here. stay away. no help at all. the other reviews giving this place a 1 star is accurate. read more

The lack of after care caused most most of my ultimate injuries. They are terrible about following through with any any of it. It's just an ongoing fight. I had 30 hours worth of help through ihss, which was absolutely worthless. Caseworker, there was very bad. Seemed like he was just waiting around to get retired. His name's Victor. Cortez out of the Santa Ana office. read more

Requested some paperwork, Friday 3 o'clock approximately, I asked the receptionist, the lady behind the desk to overlook it, and I do myself that there were some parts that were not completed. Honestly I don't believe she knew what she was doing. She just wanted to accept my paperwork knowing that it was incomplete, or didn't care and / or was ignorant. Security at that place, was very high strung When we entered. This review may change, because I want to see if they do the paperwork correctly. That should be in about a week. Thank you read more

CalOptima Health - Getting paperwork - Health Insurance Offices Near Me - Orange, California

The providers I have access to through this insurance are fairly subpar. Especially when it comes to mental health. Good luck finding any therapists who take CalOptima who are LGBTQ specialists. CalOptima's website still has binary gender options. There's not an option to filter out trans, non-binary, or even LGBTQ specialties. You can select "male or female" and then just your standard options for mental health care. It's honestly 30 years behind the times. I'm stuck with it right now because I can't afford to pay for insurance, but I will be switching when I can. When it comes to physical care, I mean...it's ok. But I got sent to a clinic and didn't have an actual steady provider. I've seen four different doctors because they keep leaving the clinic to work somewhere else. The same goes for therapists. read more

Just this past week I had the good fortune to speak with Laura, a customer service representative for Cal Optima healthcare. She was attentive, respectful, and extremely helpful. I was very pleasantly surprised with this phone call experience, not the norm, whatsoever. She was attentive and empathetic, and I can't recommend Cal Optima customer service enough. Thank you, Laura. read more

This organization pays its executives millions a year and salary and bonuses while they gladly deny access to care. You can try and get an MRI but these crooks will deny it at every turn. Sadly, people who qualify for MediCal in Orange County are stuck with this horrible health plan. read more

I'll give 2 star to this insurance i like how you disregard people who have transportation services through your insurance and you take on a new company called NEMT transportation you can't get through half the time to schedule a ride and now this company has stranded patients your totally incompetent cal optima for keeping this transportation on board your fuckin idiots read more

I don't know why there are such other bad reviews. I have been with Cal Optima over 20 years and have seen countless doctors over the years and quite a few surgeries. I think 95%of the doctors have been excellent. As good of doctors as any insurance. Their doctors are same as all the other insurances. I don't know why people have had trouble getting a person on phone because I never had. My couple complaints are a couple- very few physical therapy locations and terrible transportation situations but you will get transported one way or another but very frustrating at times if you have to use their transportation you need to call them the day of to confirm even if they send you confirmation text. Half of the drivers are terrible as well. Used this service for 2 years. The other thing that is a bummer is that they have a lot of UCI doctors listed but pretty much impossible to get approved to see any of them. I know the ins and outs of cal optima. Which if you figure it out it is fine otherwise. Like when you're waiting for a referral you don't wait for anyone to call you. You call and check and generally only takes a few days. You can also check on the website if your referral has gone through. I have an excellent PCP which if you have that you will be happy. If you need a referral to a specialist though you look on the website of search for a provider, and call the provider you're interested in seeing and make sure they're with your network otherwise you will waste a lot of time because their lists aren't always accurate because they're not updated often enough. This is something that is necessary for you to do every single time you need a referral. The one thing that they don't really have is if you need jaw surgery. I had to add other insurance for that for several months. The reason I give a good rating is the quality of the doctors / surgeons which have been overall excellent. Oh and just try not to see a surgeon that only works out of Fountain Valley Regional Hospital, worst of the worst, but my daughter's Dr was so amazing we tolerated it for one night years ago. Oh another thing is they don't have enough psychologists so if you need one you prob will have to be on a waiting list. Dentist options are waaaay better than they were years ago. But they don't cover night guards or braces or some other things like partial crowns. So there are some limitations but the doctors are very good so that is what's really important. I guess I'm just so used to it all and knowing what I need to do when I need a referral. It's all about getting referrals. read more

The grievance department with CalOptima is a waste of time. Rebeca handled the grievance case and it wasn't the best experience. The report she wrote somehow misses most of the details I give her in regards to the compliant. It appeared she just wanted to close the compliant so she doesn't go through any trouble, not sure if they are judged by the number of cases they close. She should care more for patients, specially when the old ones, and if they really record the phone calls, to report the correct details. Bottom line is the grievance case/report that Rebeca handled is pointless. It is as she was on the side of the offending medical office. read more

This is for the in person building. They have a customer service center you can see in person. They were helpful in solving my issue.

CalOptima are the bane of my existence. They are an absolute disgrace. They are so bad because they are not supervised by anyone. When Orange County opted out of regular MediCal, which has a vast system of checks and balances and grievance resolution, they doubtless were required to set up an effective system of grievance resolution. They failed to do this and on that basis are operating illegally and improperly. The California Department of Health and Human Services does not supervise CalOptima. Neither does the California Ombudsman Office, although CalOptima falsely claims that it does. The OC Board of Supervisors also does not supervise CalOptima, although I have no doubt they have a duty to do so. Typically in a beaurocracy, when a task is not the specific job of certain individuals, the job is not done by anyone. The Grievance Department is a farce.They accept any explanation in response to a grievance, and basically sweep every problem under the carpet. That is why nothing ever improves and CalOptima make the same mistakes over and over and also refuse to control the medical providers. CalOptima staff have a culture of evading member questions and a culture of hanging up on members. Often members are treated like garbage. CalOptima should be abolished. read more

Don't even bother trying to get health care from CalOptima, because it's completely worthless. The goal of CalOptima is to steal as much of the $4 billion in funding as possible. They make phony charts and graphs that convince the state auditor. Plus, you know there's a LOT of payoffs and kickbacks to state officials to keep those billions coming. But, as far as healthcare is concerned? Little to nothing, is what you will receive. I know, because I am a member and I tried to use the medical services twice. Just go down to the ER department of your closest hospital and tell them you have CalOptima and they did not provide any care for you. The physicians there will understand, because they have heard that same story many times before. The billions for the homeless work the exact same way. The money disappears. A handful of homeless people get motel rooms for a week and then back to the street they go. This is fraud, designed to enrich the few at the top, who manage to embezzle most of the money. They buy luxury homes with indoor infinity pools and a fleet of new Teslas. That's where the money goes. Not to any healthcare. Try it if you want, and see for yourself. A thousand internet reviews from other patients tell you the same things as I just told you. But, you're welcome to see for yourself. read more

I've had both Cal Optima insurance in Orange County and Medical through San Diego, and Cal Optima is the worst insurance provider I've experienced from access to doctors to approving insurance for imaging and especially their customer service. As many others have stated in their reviews, their is no oversight process or accountability for customer service providers, little if any communication so you'll likely explain yourself many times giving the same story to help each member understand your case. Long hold times and often I've called and after 30 min - 1 hr of waiting the call disconnects. ( To be clear not while driving) Customer service reps aren't trained on the changes in Cal optima and you'll likely get different information from different reps. I'd avoid if possible. read more

This review is for a customer service rep by the name of LeAnn/Lianne/Leanne who was patient and friendly. She did an outstanding job of helping me to understand my options. Thank you! read more

This has got to be the worst place in the world -- trying to get medical billing since November 2021 -- and nothing! Spoke to five different people all of which don't sound old enough to know about billing but nonetheless, it should not be that hard to produce a couple of pieces of paper! Get it together! read more

CalOptima is terrible!! Not only for patients; they use any reasons not pay Doctors!!! State need to help us in Orange county!!!

AIDS testing, family planning, pregnancy services, and treatment for STDs do not need prior authorization. Everything they send is also in Spanish and Vietnamese. New member orientation is on the second Tuesday of every month so you can learn about your responsibilities and rights. Meetings in Vietnamese are held at the Midway City Community Center. You can ask for a free interpreter when you get health care or over-the-phone. Benefits include authorized acupuncture, laboratory services (blood work, CT scan, ultrasound, and x-rays), maternity care, and medications. Care management is available for those who have cancer treatments and spinal injuries. Children with chronic illness may be eligible for the California Children's Services program if their families meet certain financial and residential requirements. Diapers, feeding tubes, and skin creams are available by prescription. If you are under 21 you may qualify for medical supplies, nutrition services, and physical therapy under through a federal program called Early and Periodic Screening, Diagnosis, and Treatment [EPSDT]. Minor consent/sensitive services for drug abuse in children under age 12 or sexual assault do not need parental consent/physician referral. Newborn care, nursing facility services, orthopedic referrals, pediatric checkups, and speech therapy are covered too. Perinatal support lasts for two months after the baby is born. Pharmacy services are limited to Orange County unless you use a contracted chain within the state. They also have classes for diabetes, quitting smoking, and stress management. read more

Have had the worst experience. First my PCP sent a referral for dermatology. The dermatologist was incompetent about skin cancer. I asked for a skin check and all he checked was my feet. He spent a total of 5 min. Still trying to find a dermatologist through them. I ended up paying out of pocket for a quality dr. Then recently I've needed a gynecologist for a possible cancerous cyst on my ovary and they've given me the run around. I went to the website checked over 6 drs and their reviews. I call caloptima to check if these drs were still active. They said our system is up to date and to let my pcp know who I want to see. I've given my pcp the names and either they could not find them in the system or the names they did find they would submit them to Caloptima. Then caloptima would would tell my pcp that those drs were not covered. I'm furious. I'm wasting my time when I need to be seen. Again today I'll be going to a gynecologist that has bad reviews and is not a specialist in endometriosis. Tried to get sent to UC Irvine but caloptima says it has to be medical Necessity. My pcp sent over the ultrasound and notes and the STILL denied!!! Caloptima needs to be audited. I'm going to see if a news channel or someone will take this story. If you've had a similar experience let me know. The more people we have the better. read more

This is for the company as a whole, my girlfriend suffered a stroke late last year and Cal Optima have been incredible from start to present. I cant thank them enough for the continued support with approving recommended thereapy from her doctors and therapists. The few times I needed to speak to them in the early stages they were informative and friendly to deal with. The company I work for pays around $400 per month for my health insurance and it doesnt even come close to the level of care she recieves from Cal Optima. read more

Cal Optima exempts itself from the federal and State of California checks and balances, and all oversight. Because of this, they are able to get away with appalling medical care, murder basically. Cal Optima is a nightmare for sick and vulnerable people who need emergency, life saving and preventive medical care. There is no reason for Cal Optima to be a funded program in Orange Country, CA. Defund Cal Optima! We need to go back with the State of California. Let's have state and federal oversight again. Quality health care for our disabled, sick and elderly. Our most vulnerable in Orange County are being taking advantage of by Cal Optima. read more

The worst insurance I've ever had, just bottom of the barrel... they will send you tremendous amounts of junk mail and surveys, but when you actually want medical care, good f****** luck. outdated provider directories, nobody's taking new patients, you never get to see M.D.'s it's always nurse practitioners and lesser people. They are incompetent, inept and utterly useless. If you're low income and would normally be on Medicare, you're forced onto it. No choice. Like i said, evil. read more

One fuckin star for cal optima insurance you say im covered for chriopractic and accupuncture and massage you so bassically you lied to me and my brother and then you cancel my appointments that i already scheduled, Cal Optima you fuckin useless bumbs read more

Worst insurance ive had. On one occasion they lost some of my records causing a delay in my prescription for over 2 weeks. Today, I'm in the ER, and im going to have to wait 2-3 days for a surgery. The hospital im at suggested I switch health insurance provider.. on their own, just based on their interaction with caloptima. I'm waiting till open enrollment, and I'm switching. read more

I was hung up on over 5 times. What is the point if a 24/7 hot line if the employees don't want to work. I have the recordings to prove how rude these people are. I called from a work phone and informed the rep it was a recorded line. Still she gave an attitude and then hung up. read more

Wtf is the point of having a number for People to call when the automated robots are the only ones you'll ever hear from??? To speak to an actual person is non existent. WT entire F!!!!!! read more

Like one of the other reviews of CAL-OPTIMA, if I could give a ZERO star rating I would!!!!!! You follow their "rules" and do what they say you need to, still NOTHING get done!! Of the TWO 4+ STAR ratings, one is ONLY "information" and the other is probably bogus!! But maybe Bryan G. got "lucky" to have Francisco L. as his rep. I have had several reasons that required me to call. On the surface, yes they are "polite, friendly and helpful," That is from the perspective of being naive! Once you deal with them on multiple occasions you soon realize one or more of the following... A) They have had occasional "hiccups?" B) Don't "know" what they are doing? C) They DO "know" what they are doing and it IS on purpose? I do not work in the field of health care nor was I schooled in it. BUT I am learning and I can see why this industry is so DUCKed up!! I would RATHER go to the DMV than have to deal with CAL-OPTIMA. They really should be sued for using "OPTIMA" in their name!! There is nothing optimal about them!! read more

Terrible, cannot reach a person. Very good use of a phone tree to keep people from getting service.

Big Thank you to Rachel at customer service who was just so kind and compassionate towards my problem, but also effective in solving an issue I had! Thank you so much! read more

Four days trying to help my friend get another new primary physician. Website not managed well. Doctors drop out and system does not know it. You real just have to stay on them to get help. read more

Over the years, I have been provided with insurance through CalOptima under the Monarch Family Health. I expected my experience to be poor, but have been surprised that I have found equally great physicians through my insurance plan. I have had no problems with doctors. It's a little difficult to find referral specialists who are close to my home, however if you try the physician assigned and do not like them or their philosophy, you can discuss other options. I have been able to get referrals to doctors out of network, closer to home, fully covered. Within the past year, I've had some medication brand coverage issues (which I believe is due to some recent changes made by Cal-Optima's coverage) but overall I am still satisfied with my care. read more

I am more than disappointed with this county "program." To say the least, it's completely inadequate. The level of service offered by their "contracted" medical physicians and facilities is unacceptable. I have absolutely zero faith in this system. I suggest that the state of California, or rather the Federal government, conduct a systematic investigation of CalOptima, with special regard to their office of risk management. read more

I have Breast cancer and had numerous surgeries and needed pain medication, so they flagged me for taking prescribed medication for pain for cancer treatment. They treated me like a drug addict instead of a human being battling cancer. I actually didn't even take the meds very often so I'm not sure what they were talking about. They also canceled my insurance once without even notifying me first. I had to go through hell to get it re instated only for a month. So unhappy with them. read more

I just got assistance from a gentleman named Francisco L., who assisted me on an ongoing medicine issue I'm trying to get resolved and was very helpful, knowledgeable, friendly, and helped me get status to the minute on my case. He's fairly new to working in the front end of caloptima so I was even more impressed with how great he was on the phone as he's used to being a person who does work in the back end of the administrative part of the company. He pulled up my case and gave me up to the minute status and even emailed someone asking them to continue following up on it and to make it a priority as much as possible. This is the kind of employee that deserves a raise so if there's any bosses that are watching or listening to Yelp, which they should, this is the kind of employee you want to keep and give raises to because you could just tell in his voice that he cares. I did get hung up on the first three times so your system for the phone definitely need some work but I still gave you a 5 because of your employee. read more