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Customer Service (619) 543-8800 (option #3)
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San Diego South County

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MPMG proudly accepts the following Medicare Advantage plans:

AetnaAnthem Blue Cross
Care1stHealth Net
HumanaSCAN
UnitedHealthcare

MPMG proudly accepts the following Commercial health plans:

AetnaAnthem Blue Cross
Blue ShieldHealth Net
Scripps Health Plan
UnitedHealthcare

"Top Ranked IPA in San Diego for patient satisfaction & quality measures"


Frequently Asked Questions

Categories:

Changes To Your Information or Status
Physicians, Urgent Cares & Facilities
General Information
Billing & Co-pays
Referrals/Authorizations
Changes To Your Information or Status   Return to top
Q.How do I change my name or address?
Answer: You will need to contact your health plan in order to change your name or address. Because your health plan relies on your employer to regularly provide member eligibility information, members are encouraged to contact their employers with name or address changes to ensure that eligibility information is current and correct. After you have updated your information with your health plan, please contact our Customer Service department to ensure that we have your updated information.
Q.How can I cover my newborn?
Answer: Contact your employer's benefits department for instructions and to obtain the proper forms. In general, an eligible newborn child is covered for 31 days from his/her date of birth. To continue coverage beyond this initial 31 day period, the eligible child must be enrolled within 31 days of birth and any applicable premium must be paid. Special provisions may apply to legally adopted children. Contact your health plan for details.
Q.What if I have an emergency while on vacation or outside of my network?
Answer: When an emergency strikes, your health care should be your top priority
  • If you are experiencing acute symptoms that you believe could result in serious jeopardy to your health or your unborn child's or serious impairment or dysfunction of your body, please seek medical help as quickly as possible by either calling 911 or going to the nearest emergency hospital.
  • After assessing and stabilizing your condition, the emergency room should try to contact your primary care physician and health plan.
  • You should notify your primary care physician as soon as possible after receiving emergency care or urgently needed services.
  • All follow-up care must be coordinated through your primary care physician.
  • You will be responsible for the appropriate emergency copayment.
Q.What are my options after I turn 65?
Answer: 

This is the year for a major milestone in your life - turning 65. Perhaps you have already retired or are getting ready for that change to your life. In any case, at 65 you need to apply for Medicare coverage. The Social Security Administration advises "people to file for Medicare benefits 3 months before age 65".* Failure to apply could result in financial penalties.

You can make an appointment at your local social security office for a consultation appointment and to enroll. Information is also available at the social security website, or by calling (800)772-1213 and at the Medicare website, or by calling (800)633-4227.

Once you have enrolled with Medicare, your physician and MPMG can assist you with some of your decisions. MPMG provides healthcare services for close to 6,000 Medicare members and our physicians are contracted with six HMO Health Plans-Aetna, Anthem Blue Cross, Health Net, Humana, SCAN and Secure Horizons.

Let us use this experience to assist you. Our staff can talk with you about your choices and help you decide what is best for you.

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.

Physicians, Urgent Cares & Facilities   Return to top
Q.What is my Primary Care Physician's phone number?
Answer: Your Primary Care Physician phone number is on your insurance card or you may call Customer Service at 1-619-543-8800, option #3.
Q.What Urgent Care can I go to?
Answer: To get the correct Urgent Care you need to call your Primary Care Physician first to see if the doctor can see you. If your doctor is unable to see you he/she will direct you to the correct Urgent Care. If after hours the office voicemail will have directions for you to follow. You may also call Customer Service for this information at 1-619-543-8800, option #3; or click here for a list of Urgent Care facilities.
Q.How do I change my Primary Care Physician?
Answer: To change your Primary Care Physician you will need to call your insurance company who will make the change for you. Once this is done the insurance company will notify the medical group.
Q.Is my specialist an MPMG doctor?
Answer: To find out if your Specialist is a part of Mercy Physicians Medical Group please call Customer Service at 1-619-543-8800, option #3.
Q.What if my Primary Care Physician (PCP) leaves the network?
Answer: If your doctor leaves the network, you will be contacted in advance by your health plan. You will be given the opportunity to select a new PCP who participates in your network. You may call your health plan or access your health plan's webpage for a listing of participating credentialed PCPs.
General Information    Return to top
Q.Who/what is NAMM?
Answer: NAMM is North American Medical Management. We work with your insurance company to manage your healthcare.
Q.How do I voice a concern?
Answer: 

We strive to provide the best service for you and are interested in your feedback.

Examples of When to file a Complaint or Grievance

Complaint or Grievance

If you are dissatisfied with the service provided by your primary care physician, medical group or any provider affiliated with your medical group, you have the right to file a complaint or grievance.

Appeal

If your PCP has requested services on your behalf and you do not agree with the decision, you have the right to file an appeal.

How to File

If you need to file an appeal or grievance, please contact your health plan at the number listed on your health plan ID card.

Appeals, complaints, and grievances should be submitted to your health plan. Because patient satisfaction is our top priority, we will work closely with your health plan to ensure the highest of quality care. In addition, you can contact Customer Service at (619) 543-8800, option #3. We will be happy to document and forward your concern to our Quality department who will look at and determine how we can improve our service. Remember, in order to formally file a grievance, you must contact your health plan directly. Due to provider confidentiality regulations, we are unable to notify members of grievance outcomes.

For your convenience, you can download the official health plan Appeal and Grievance form from our website. The form must be completed and returned directly to your health plan. The form includes the grievance address, phone number, and fax number for your specific health plan.

Q.Who Can Access My Information?
Answer: 

We understand that medical information about you and your health is personal. We are committed to protecting medical information about you

We are required by HIPAA to validate your affiliation with our medical group. Our policy is that you provide us with your health plan subscriber/member number when calling the Customer Service department. We cannot accept social security numbers as identification.

If you are not the subscriber or are calling regarding your spouse or child, we may need permission to speak with you. Call our Customer Service department for details.

If you need a friend or relative to speak on your behalf, you will need to complete an Authorization for The Use and/Or Disclosure Of Protect Health Information (PHI) form.

  • Click the above link to download the form or contact the Customer Service department to have it mailed to you.
  • Please be sure to sign the form. We cannot accept PHI forms without your signature.
  • Mail completed and signed forms to our management company:
         NAMM California
         PO Box 6902
         Rancho Cucamonga, CA 91729-6902
         Attn: Customer Service - Online

Do not hesitate to contact the Customer Service department if you have questions about or need assistance completing the PHI form.

Contact Customer Service

*Please note that the Customer Service department does not have access to your medical records. Please contact your PCP for information regarding your medical records.

Billing & Co-pays    Return to top
Q.I am receiving a bill?
Answer: If you received a bill please call Customer Service at 1-619-543-8800, option #3.
Q.What is my co-payment?
Answer: For your correct co-payment or benefits you need to call your insurance company directly. The phone number is on your insurance card or you may call Customer Service at 1-619-543-8800, option #3 to get that phone number.
Referrals/Authorizations    Return to top
Q.How do I obtain an authorization?
Answer: To get an authorization you need to have your Primary Care Physician submit the request to the medical group.
Q.What is the status of my authorization?
Answer: To get status of your authorization you need to call your Primary Care Physician.
Q.My authorization was denied how do I appeal that decision?
Answer: To appeal a denied authorization/referral you need to contact your insurance company. The insurance company will review your denied authorization and either overturn or uphold the decision.