Mercy Physicians Medical Group Frequently Asked Questions

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<div data-qahandle="sub-hero-banner" class="sub-banner__container"> <div class="sub-banner__img"></div> <div class="sub-banner__gradient coloroverly__whiteover"></div> <div class="row sub-banner__container__inner"> <div class="sub-banner__side-content-container"> </div> <div class="banner__sub-hero--content-container banner__main-content"> <div class="sub-banner__content"> <h1 class="sub-banner__mainheading">FAQs</h1> <div class="banner__main-hero--cta"> <a class="button" href="/es/preguntas-frecuentes.html"> Ver preguntas frecuentes en Español <span class="fa fa-angle-right" aria-hidden="true"></span> </a> </div> </div> </div> </div> </div> </div> <div class="column-full section"> <div class="row--padding"> <div class="row row--small"> <div class="col-full"><div class="text silverplatter parbase section"><div class="show-in-edit-mode faux-edit-bar">Text</div> <div promo-lpos="" promo-name=""> <div class="text-component text-inner"><p>Below are answers to common questions about Mercy Physicians Medical Group (MPMG).<br /> </p> <h2 style=" text-align: center; "><span class="delta">Changes to your information </span><br /> </h2> </div> </div> </div> <div class="accordion section"> <div class="show-in-edit-mode faux-edit-bar">Accordion Block</div> <section class="accordion-inner accordion__faq"> <ul class="accordion__list unstyled"> <li class="accordion-list-items"> <button class="button--none accordion__header accordion__toggle" aria-expanded="false"> <h3 class="accordion-question epsilon">How do I change my name or address? <i class="fa fa-angle-down accordion_indicator" aria-hidden="true"></i> </h3> </button> <div class="accordion_content hide"> <div class="accordion-flex-container"> <div class="accordion-flex-item accordion__left"> <p>Please give your new information to both your health plan and your employer. Your health plan relies on your employer for your eligibility status. Because of this, it's important that they both have the most current information. </p> <p>Once your health plan has your new information, please give us a call so we can update our records, too.</p> </div> </div> <button class="button--none accordion__close accordion__toggle" aria-expanded="false"> CLOSE <span class="fa fa-angle-up" aria-hidden="true"></span> </button> </div> <div class="accordion-divide"><span>OR</span></div> </li> <li class="accordion-list-items"> <button class="button--none accordion__header accordion__toggle" aria-expanded="false"> <h3 class="accordion-question epsilon">How do I add my newborn to my insurance? <i class="fa fa-angle-down accordion_indicator" aria-hidden="true"></i> </h3> </button> <div class="accordion_content hide"> <div class="accordion-flex-container"> <div class="accordion-flex-item accordion__left"> <p>Please ask your employer's benefits department for directions and the proper forms. </p> <p>In general, a newborn child who qualifies is covered for 31 days from the date of birth. To cover your child after that, you'll need to enroll your child in a health care plan. </p> <p>Be sure to do this during the first 31 days, and pay any premiums that are due. There may be different rules for legally adopted children. Please ask your health plan for details.</p> </div> </div> <button class="button--none accordion__close accordion__toggle" aria-expanded="false"> CLOSE <span class="fa fa-angle-up" aria-hidden="true"></span> </button> </div> <div class="accordion-divide"><span>OR</span></div> </li> <li class="accordion-list-items"> <button class="button--none accordion__header accordion__toggle" aria-expanded="false"> <h3 class="accordion-question epsilon">What if I have an emergency while on vacation or outside of my network? <i class="fa fa-angle-down accordion_indicator" aria-hidden="true"></i> </h3> </button> <div class="accordion_content hide"> <div class="accordion-flex-container"> <div class="accordion-flex-item accordion__left"> <p>Please seek immediate medical help by calling 911 or going to the nearest emergency room (ER). The ER should try to contact your primary care doctor and health plan to tell them about the care you received. </p> <p>Please see your primary care doctor within five days after your ER visit. Your primary care doctor should make sure you get all of your follow-up care. </p> <p>You will be responsible for the appropriate emergency copay.</p> </div> </div> <button class="button--none accordion__close accordion__toggle" aria-expanded="false"> CLOSE <span class="fa fa-angle-up" aria-hidden="true"></span> </button> </div> <div class="accordion-divide"><span>OR</span></div> </li> <li class="accordion-list-items"> <button class="button--none accordion__header accordion__toggle" aria-expanded="false"> <h3 class="accordion-question epsilon">What are my options after I turn 65? <i class="fa fa-angle-down accordion_indicator" aria-hidden="true"></i> </h3> </button> <div class="accordion_content hide"> <div class="accordion-flex-container"> <div class="accordion-flex-item accordion__left"> <p>This is the year for a major milestone in your life — turning 65. At 65, you need to sign up for Medicare. The Social Security Administration (SSA) advises people to "sign up for Medicare three months before age 65."* <br /> </p> <p>To learn more about Medicare and to sign up, you can make an appointment at your local Social Security Administration (SSA) office. </p> <p>Other ways to get information about Medicare are:</p> <ul><li>Call SSA at 1-800-772-1213. Or visit <a target="_blank">ssa.gov</a>.</li><li>Call Medicare at 1-800-MEDICARE (TTY 1-877-486-2048), 24 hours a day, 7 days a week. Or visit <a target="_blank">medicare.gov</a>.</li></ul> <p>Once you've signed up for Medicare, we can help you with your plan choices. We work with <a href="https://www.mpmgdocs.com/en/health-care-services/become-member/medicare/licensed-agents.html" adhocenable="false">health insurance agencies</a> who can help answer your questions about Medicare. We accept most Medicare plans. </p> <p>Just as you prepared for the driving test at 16, and voting at 21, now is the time to prepare for Medicare at 65. We look forward to helping you take care of these important health care decisions.</p> <p>* <a href="https://www.ssa.gov/benefits/medicare/" target="_blank" rel="noopener noreferrer">https://www.ssa.gov/benefits/medicare/</a><i></i><br /> </p> </div> </div> <button class="button--none accordion__close accordion__toggle" aria-expanded="false"> CLOSE <span class="fa fa-angle-up" aria-hidden="true"></span> </button> </div> <div class="accordion-divide"><span>OR</span></div> </li> </ul> </section> </div> <div class="text silverplatter parbase section"><div class="show-in-edit-mode faux-edit-bar">Text</div> <div promo-lpos="" promo-name=""> <div class="text-component text-inner"><h2 style=" text-align: center; "><span class="delta">Doctors and medical network </span><br /> </h2> </div> </div> </div> <div class="accordion section"> <div class="show-in-edit-mode faux-edit-bar">Accordion Block</div> <section class="accordion-inner accordion__faq"> <ul class="accordion__list unstyled"> <li class="accordion-list-items"> <button class="button--none accordion__header accordion__toggle" aria-expanded="false"> <h3 class="accordion-question epsilon">What is my primary care doctor's phone number? <i class="fa fa-angle-down accordion_indicator" aria-hidden="true"></i> </h3> </button> <div class="accordion_content hide"> <div class="accordion-flex-container"> <div class="accordion-flex-item accordion__left"> <p>You can find your primary care doctor's phone number on your health insurance card. Or, you may call customer service at:</p> <p> </p> <p> </p> <p> </p> <p style=" margin-left: 40.0px; ">1-619-543-8800, choose option 3<br /> Mon.–Fri.: 8 a.m.–5 p.m. PT, except holidays</p> <p> </p> <p> </p> <p> </p> </div> </div> <button class="button--none accordion__close accordion__toggle" aria-expanded="false"> CLOSE <span class="fa fa-angle-up" aria-hidden="true"></span> </button> </div> <div class="accordion-divide"><span>OR</span></div> </li> <li class="accordion-list-items"> <button class="button--none accordion__header accordion__toggle" aria-expanded="false"> <h3 class="accordion-question epsilon">Where can I go for urgent care? <i class="fa fa-angle-down accordion_indicator" aria-hidden="true"></i> </h3> </button> <div class="accordion_content hide"> <div class="accordion-flex-container"> <div class="accordion-flex-item accordion__left"> <p>To get the correct urgent care, please call your primary care doctor first and ask if the doctor can see you. If your doctor can't see you, he or she will direct you to the correct urgent care. </p> <p> </p> <p>If it's after hours, the office voicemail will have directions for you to follow. You can also find the list of urgent care locations <a></a><a href="/en/locations-nav/urgent-care-locations.html">here</a>.</p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> </div> </div> <button class="button--none accordion__close accordion__toggle" aria-expanded="false"> CLOSE <span class="fa fa-angle-up" aria-hidden="true"></span> </button> </div> <div class="accordion-divide"><span>OR</span></div> </li> <li class="accordion-list-items"> <button class="button--none accordion__header accordion__toggle" aria-expanded="false"> <h3 class="accordion-question epsilon">How do I change my primary care doctor? <i class="fa fa-angle-down accordion_indicator" aria-hidden="true"></i> </h3> </button> <div class="accordion_content hide"> <div class="accordion-flex-container"> <div class="accordion-flex-item accordion__left"> <p>To change your primary care doctor, call your health plan. The plan will make the change, and tell the medical group about the change.<br /> </p> </div> </div> <button class="button--none accordion__close accordion__toggle" aria-expanded="false"> CLOSE <span class="fa fa-angle-up" aria-hidden="true"></span> </button> </div> <div class="accordion-divide"><span>OR</span></div> </li> <li class="accordion-list-items"> <button class="button--none accordion__header accordion__toggle" aria-expanded="false"> <h3 class="accordion-question epsilon">Is my specialist part of your network? <i class="fa fa-angle-down accordion_indicator" aria-hidden="true"></i> </h3> </button> <div class="accordion_content hide"> <div class="accordion-flex-container"> <div class="accordion-flex-item accordion__left"> <p>To find out, please call customer service at:</p> <p> </p> <p style=" margin-left: 40.0px; ">1-619-543-8800, choose option 3<br /> Mon.–Fri.: 8 a.m.–5 p.m. PT, except holidays</p> <p> </p> <p> </p> <p> </p> </div> </div> <button class="button--none accordion__close accordion__toggle" aria-expanded="false"> CLOSE <span class="fa fa-angle-up" aria-hidden="true"></span> </button> </div> <div class="accordion-divide"><span>OR</span></div> </li> <li class="accordion-list-items"> <button class="button--none accordion__header accordion__toggle" aria-expanded="false"> <h3 class="accordion-question epsilon">What if my primary care doctor leaves the network? <i class="fa fa-angle-down accordion_indicator" aria-hidden="true"></i> </h3> </button> <div class="accordion_content hide"> <div class="accordion-flex-container"> <div class="accordion-flex-item accordion__left"> <p>If your doctor leaves the network, your health plan will contact you and help you choose a new doctor in your network. To find a network doctor, you can call your health plan or visit your plan's webpage.<br /> </p> </div> </div> <button class="button--none accordion__close accordion__toggle" aria-expanded="false"> CLOSE <span class="fa fa-angle-up" aria-hidden="true"></span> </button> </div> <div class="accordion-divide"><span>OR</span></div> </li> </ul> </section> </div> <div class="text silverplatter parbase section"><div class="show-in-edit-mode faux-edit-bar">Text</div> <div promo-lpos="" promo-name=""> <div class="text-component text-inner"><h2 style=" text-align: center; "><span class="delta">General information </span><br /> </h2> </div> </div> </div> <div class="accordion section"> <div class="show-in-edit-mode faux-edit-bar">Accordion Block</div> <section class="accordion-inner accordion__faq"> <ul class="accordion__list unstyled"> <li class="accordion-list-items"> <button class="button--none accordion__header accordion__toggle" aria-expanded="false"> <h3 class="accordion-question epsilon">Who or what is Optum? <i class="fa fa-angle-down accordion_indicator" aria-hidden="true"></i> </h3> </button> <div class="accordion_content hide"> <div class="accordion-flex-container"> <div class="accordion-flex-item accordion__left"> NAMM California is North American Medical Management California, Inc. (NAMM). NAMM is now known as Optum. Optum works with your health plan to help organize your health care. </div> </div> <button class="button--none accordion__close accordion__toggle" aria-expanded="false"> CLOSE <span class="fa fa-angle-up" aria-hidden="true"></span> </button> </div> <div class="accordion-divide"><span>OR</span></div> </li> <li class="accordion-list-items"> <button class="button--none accordion__header accordion__toggle" aria-expanded="false"> <h3 class="accordion-question epsilon">How do I voice a concern? <i class="fa fa-angle-down accordion_indicator" aria-hidden="true"></i> </h3> </button> <div class="accordion_content hide"> <div class="accordion-flex-container"> <div class="accordion-flex-item accordion__left"> <p>We strive to provide the best service for you and are interested in your feedback.</p> <h2><span class="delta"><b>Examples of when to file a complaint or grievance</b></span></h2> <p><b>Complaint or grievance</b><br /> You have the right to tell us if you're unhappy with any of your medical care or service. This is called filing a grievance.</p> <p><b>Appeal</b><br /> If your doctor has requested services for you and you don't agree, you have the right to file an appeal.</p> <p><b>How to file</b><br /> If you need to file an appeal or grievance, please call your health plan. You can find your health plan’s phone number on your health plan ID card.</p> <p>Send your appeals, complaints and grievances to your health plan. Member satisfaction is our top priority. We will work closely with your health plan to make sure you get the highest quality of care. In addition, you can call customer service at:</p> <p style=" margin-left: 40.0px; ">1-800-956-8000, TTY 711<br /> Mon.–Fri.: 8:30 a.m.–5 p.m. PT, except holidays</p> <p>We will be happy to document and send your concern to our quality department. They will look at and determine how we can improve our service. Remember, in order to file a formal grievance, you must contact your health plan directly.</p> <p>Please note: We must follow provider confidentiality law. This means we are unable to tell members about grievance outcomes.</p> <p>You can find the official health plan appeal and grievance form on our website. You'll need to send the completed form directly to your health plan. The form includes the grievance address, phone number and fax number for your specific health plan.</p> <p>If you have an individual or family plan, use <a adhocenable="false"></a><a></a><a href="/en/resources/resources/appeal-grievance.html">this form</a>.</p> <p>If you have a Medicare plan, use <a adhocenable="false"></a><a></a><a href="/en/resources/resources/medicare-appeal-grievance.html">this form</a>.</p> </div> </div> <button class="button--none accordion__close accordion__toggle" aria-expanded="false"> CLOSE <span class="fa fa-angle-up" aria-hidden="true"></span> </button> </div> <div class="accordion-divide"><span>OR</span></div> </li> <li class="accordion-list-items"> <button class="button--none accordion__header accordion__toggle" aria-expanded="false"> <h3 class="accordion-question epsilon">Who can see my medical information? <i class="fa fa-angle-down accordion_indicator" aria-hidden="true"></i> </h3> </button> <div class="accordion_content hide"> <div class="accordion-flex-container"> <div class="accordion-flex-item accordion__left"> <p>We understand that medical information about you and your health is personal. We’re committed to protecting medical information about you.</p> <p>Your medical information is protected by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). According to HIPAA, we must confirm that you are a member with our medical group. </p> <p>To do so, we ask for your health plan subscriber or member number when you call customer service. We can't accept social security numbers. </p> <p>If you are not the subscriber or are calling about your spouse or child, we may need permission to speak with you. Call our customer service department for details.</p> <p>If you need a friend or relative to speak on your behalf, you will need to complete the Disclosure of protected health information form. You can find the form <a></a><a adhocenable="false" href="/en/resources/resources/information-disclosure.html">here</a>. Or, call customer service and ask us to mail it to you.</p> <p><b>Please be sure to sign the form. We can't accept PHI forms without your signature.</b></p> <p>Mail the completed and signed form to:</p> <p style=" margin-left: 40.0px; ">Optum Care Network<br /> Attn: Customer Service – online<br /> P.O. Box 6902<br /> Rancho Cucamonga, CA 91729-6902</p> <p>If you have questions or need help with the form, please call us. Note: Customer service can't look into your medical records for you. Please call your doctor for your medical information.</p> </div> </div> <button class="button--none accordion__close accordion__toggle" aria-expanded="false"> CLOSE <span class="fa fa-angle-up" aria-hidden="true"></span> </button> </div> <div class="accordion-divide"><span>OR</span></div> </li> <li class="accordion-list-items"> <button class="button--none accordion__header accordion__toggle" aria-expanded="false"> <h3 class="accordion-question epsilon">How can I get more information on how referral decisions are made? <i class="fa fa-angle-down accordion_indicator" aria-hidden="true"></i> </h3> </button> <div class="accordion_content hide"> <div class="accordion-flex-container"> <div class="accordion-flex-item accordion__left"> Members may obtain a copy of the actual benefit provision, guideline, protocol or other similar criterion on which a referral decision was based free of charge by calling your <a href="https://www.mpmgdocs.com/en/about-mpmg/contact.html">Optum Care Network’s Customer Service department.</a> </div> </div> <button class="button--none accordion__close accordion__toggle" aria-expanded="false"> CLOSE <span class="fa fa-angle-up" aria-hidden="true"></span> </button> </div> <div class="accordion-divide"><span>OR</span></div> </li> </ul> </section> </div> <div class="text silverplatter parbase section"><div class="show-in-edit-mode faux-edit-bar">Text</div> <div promo-lpos="" promo-name=""> <div class="text-component text-inner"><h2 style=" text-align: center; "><span class="delta">Billing and copays</span><br /> </h2> </div> </div> </div> <div class="accordion section"> <div class="show-in-edit-mode faux-edit-bar">Accordion Block</div> <section class="accordion-inner accordion__faq"> <ul class="accordion__list unstyled"> <li class="accordion-list-items"> <button class="button--none accordion__header accordion__toggle" aria-expanded="false"> <h3 class="accordion-question epsilon">Why did I get a bill? <i class="fa fa-angle-down accordion_indicator" aria-hidden="true"></i> </h3> </button> <div class="accordion_content hide"> <div class="accordion-flex-container"> <div class="accordion-flex-item accordion__left"> <p>If you have questions about a bill, please call customer service at:</p> <p> </p> <p style=" margin-left: 40.0px; ">1-800-956-8000, TTY 711<br /> Mon.–Fri.: 8:30 a.m.–5:00 p.m. PT, except holidays</p> <p> </p> </div> </div> <button class="button--none accordion__close accordion__toggle" aria-expanded="false"> CLOSE <span class="fa fa-angle-up" aria-hidden="true"></span> </button> </div> <div class="accordion-divide"><span>OR</span></div> </li> <li class="accordion-list-items"> <button class="button--none accordion__header accordion__toggle" aria-expanded="false"> <h3 class="accordion-question epsilon">What is my copay? <i class="fa fa-angle-down accordion_indicator" aria-hidden="true"></i> </h3> </button> <div class="accordion_content hide"> <div class="accordion-flex-container"> <div class="accordion-flex-item accordion__left"> <p>For your correct copay or benefits, please call your health plan. The phone number is on your insurance card. If you can’t find your insurance company’s phone number, we can help. Call customer service at:<br /> </p> <p> </p> <p style=" margin-left: 40.0px; ">1-800-956-8000, TTY 711<br /> Mon.–Fri.: 8:30 a.m.–5:00 p.m. PT, except holidays</p> <p> </p> </div> </div> <button class="button--none accordion__close accordion__toggle" aria-expanded="false"> CLOSE <span class="fa fa-angle-up" aria-hidden="true"></span> </button> </div> <div class="accordion-divide"><span>OR</span></div> </li> <li class="accordion-list-items"> <button class="button--none accordion__header accordion__toggle" aria-expanded="false"> <h3 class="accordion-question epsilon">How do I get an authorization? <i class="fa fa-angle-down accordion_indicator" aria-hidden="true"></i> </h3> </button> <div class="accordion_content hide"> <div class="accordion-flex-container"> <div class="accordion-flex-item accordion__left"> To get an authorization, ask your primary care doctor to send the request to the medical group.<br /> </div> </div> <button class="button--none accordion__close accordion__toggle" aria-expanded="false"> CLOSE <span class="fa fa-angle-up" aria-hidden="true"></span> </button> </div> <div class="accordion-divide"><span>OR</span></div> </li> <li class="accordion-list-items"> <button class="button--none accordion__header accordion__toggle" aria-expanded="false"> <h3 class="accordion-question epsilon">What is the status of my authorization? <i class="fa fa-angle-down accordion_indicator" aria-hidden="true"></i> </h3> </button> <div class="accordion_content hide"> <div class="accordion-flex-container"> <div class="accordion-flex-item accordion__left"> To get the status of your authorization, you need to call your primary care doctor.<br /> </div> </div> <button class="button--none accordion__close accordion__toggle" aria-expanded="false"> CLOSE <span class="fa fa-angle-up" aria-hidden="true"></span> </button> </div> <div class="accordion-divide"><span>OR</span></div> </li> <li class="accordion-list-items"> <button class="button--none accordion__header accordion__toggle" aria-expanded="false"> <h3 class="accordion-question epsilon">My authorization was denied. How do I appeal that decision? <i class="fa fa-angle-down accordion_indicator" aria-hidden="true"></i> </h3> </button> <div class="accordion_content hide"> <div class="accordion-flex-container"> <div class="accordion-flex-item accordion__left"> To appeal a denied authorization or referral, call your insurance company. The insurance company will review your denied authorization and either overturn or uphold the decision.<br /> </div> </div> <button class="button--none accordion__close accordion__toggle" aria-expanded="false"> CLOSE <span class="fa fa-angle-up" aria-hidden="true"></span> </button> </div> <div class="accordion-divide"><span>OR</span></div> </li> </ul> </section> </div> </div> </div> </div> </div> <div class="column-full section"> <div class="row--padding"> <div class="row row--medium"> <div class="col-full"><div class="arrow-divider section"> <div class="show-in-edit-mode faux-edit-bar">Horizontal Rule</div> <div class="arrow-divider__heading"> <h2 class="subhead"> Helpful resources </h2> </div> <div class="divider divider--arrow true"></div> </div> <div class="card-box section"> <div class="show-in-edit-mode faux-edit-bar">Card Box</div> <div class="cardmaterialctanum-1 material-card-image-detail-cta"> <div class="mcard mcard__image__detail__cta"> <div class="mcard__image-container"> <img src="/content/dam/optum3/namm/images/primecare-healthplanpartners-member-basecard1.jpg" alt=""/> </div> <div class="mcard__image-detail mcard__image-detail--border-top mcard__image-detail--border-bottom align-left"> <h3 class="mcard__imgcta__title"> Become a member </h3> <p class="mcard__detail__descption"> It’s easy if you know what steps to take. </p> </div> <div class="mcard__cta__link align-left"> <a class="mcard__cta-link button-link" href="/en/health-care-services/become-member.html"> <span class="">Learn more</span> <span class="fa fa-chevron-right" aria-hidden="true"></span> </a> </div> </div> <script type="text/javascript"> $("document").ready( function(event) { // Add event handlers on document ready var $cards = $(".mcard__image__detail__cta"), ctaHandledClass = "mcard--handled"; $(".mcard__cta__linktxt").addClass("button-link").removeClass("mcard__cta__linktxt"); $cards.each( function(cardIndex, card) { var $card = $(card); if ($card.hasClass(ctaHandledClass)) { return; } else { $card.addClass(ctaHandledClass); $card.on( "click", function(event) { // Click handler that makes the entire card clickable, // rather than just the call-to-action (CTA) button. var $ctaLink = $(this).find( ".mcard__cta-link" ); if ( $ctaLink.length < 1 ) { // There is no CTA button. $(this).off(event.type); $(this).removeClass(ctaHandledClass); return; } else { // There should only be one button, but use the first one // just to be safe. 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