Covered Medical Services
Covered Medical Services Include:
(Click on the services for more information.)
If you have a life-threatening emergency, call 9-1-1 or go to the hospital in your Medical Home Network. Healthy San Francisco only covers the cost of services at the hospital in your Medical Home Network. Please see a list of hospitals in the Medical Home Directory or in the Participant Handbook.
Medical emergencies are life-threatening or seriously dangerous illnesses or injuries. These may include:
- Difficulty breathing and/or shortness of breath
- Chest or upper stomach pain or feeling pressure in your chest
- Fainting spells or sudden dizziness or weakness
- Uncontrolled bleeding
- Severe vomiting or diarrhea
- Feelings that you want to hurt yourself or others
Ambulance services are covered ONLY for life-threatening emergencies and ONLY for transportation within San Francisco.
It is always best to receive care from your Medical Home. However, if you need to see a doctor right away because you are in pain, check with your Medical Home to see if they can see you in their clinic.
Urgent Care services are available at the hospital in your Medical Home Network. Healthy San Francisco only covers the cost of services at the hospital in your Medical Home Network. Please see the listed urgent care location for each Medical Home in the Medical Home Directory.
Ambulance services are covered by Healthy San Francisco ONLY for life-threatening emergencies and ONLY for transportation within San Francisco.
If you have a life-threatening emergency, call 9-1-1 to get an ambulance.
Healthy San Francisco provides hospital care at the hospital in your Medical Home Network.
Except in an emergency, you will need a doctor or a specialist in your Medical Home Network to refer you for hospital care.
Healthy San Francisco only covers the cost of services at the hospital in your Medical Home Network. Please see a list of hospitals in the Medical Home Directory or in the Participant Handbook.
Treatment of routine medical conditions, regular check-ups and health screenings are an important part of your ongoing health care treatment. All of these services are covered by Healthy San Francisco and are provided by your Medical Home.
Make appointments directly with your Medical Home for regular check-ups.
Healthy San Francisco will pay for approved prescription drugs prescribed by your Primary Care Provider at your Medical Home. Your Medical Home has a designated pharmacy or other resource for picking up prescription medicines. Designated pharmacies for each Medical Home are listed in the Medical Home Directory and Participant Handbook.
As a Healthy San Francisco Participant, you can get prescription medicines. They’ll be prescribed when you need them by your Medical Home doctor. Healthy San Francisco provides certain medications that have been approved for use. Any medications that have not been approved are not paid for by Healthy San Francisco.
Your Medical Home has a designated pharmacy or other resources for picking up prescription medicines. Locate your Medical Home clinic using this Interactive Medical Home map for info on where you can get prescriptions filled.
Specialists are doctors who see patients with special health care conditions, such as asthma, diabetes, or heart problems. Your Medical Home will refer you to a specialist if you need expert advice or treatment for a specific problem.
Some Medical Homes have specialists on staff who can treat you. Others will refer you to specialists at one of the hospitals in your Medical Home Network. You may not see a specialist without a referral from your Medical Home. If you see a specialist without a referral from your Medical Home, Healthy San Francisco will not pay for the treatment you receive.
Healthy San Francisco Participants may be treated for confidential mental health services, such as individual counseling for depression, anxiety, panic, or help with other emotional problems.
When clinically appropriate, these services are available to you either through your Medical Home or by contacting San Francisco Community Behavioral Health Services at:
Local Callers: (415) 255-3737
Toll-Free Callers: (888) 246-3333
TDD/TTY for People who are Deaf, Hard-of-Hearing, or have Speech Disabilities: (888) 484-7200
Healthy San Francisco Participants can access services for alcohol or other drug problems from San Francisco Community Behavioral Health Services.
Your communication with them will be kept strictly confidential.
- Local Callers: (415) 255-3737
- Toll-Free Callers: (888) 246-3333
- TDD/TTY for People who are Deaf, Hard-of-Hearing, or have Speech Disabilities: (888) 484-7200
If you need medical or laboratory tests, they may be performed either at your Medical Home or at the hospital in your Medical Home Network.
Not all Medical Homes provide testing or laboratory work. For more information, call your Medical Home or ask your doctor when the tests are ordered.
Family Planning services are available at most Healthy San Francisco Medical Homes. These may include:
- Birth control
- Pregnancy testing
- Sexually transmitted disease testing
Healthy San Francisco Participants can request an appointment for family planning services. Call your Medical Home to make an appointment for OB/GYN and other family planning services.
Durable Medical Equipment is equipment your Primary Care Provider at your Medical Home may prescribe for you, such as a wheelchair or crutches.
Check with your Medical Home about where to take a prescription for durable medical equipment. The telephone number for your Medical Home is located on your Healthy San Francisco Participant ID Card or in the Medical Home Directory.
Healthy San Francisco is a limited health access program.
There are certain services that are not included in Healthy San Francisco. The following is only a partial list of services that are not provided by Healthy San Francisco:
- Allergy Testing & Injections
- Gastric by-pass Surgery & Services
- Genetic Testing & Counseling
- Long-term Care
- Organ Transplants
- Non-Emergency Transportation
- Travel Immunizations
- Hearing Aids
Healthy San Francisco does not provide sexual reassignment surgery. However, Participants interested in sexual reassignment surgery may seek this service through a separate program offered by the San Francisco Department of Public Health. Get more information on the sexual reassignment surgery program by clicking here.