FAQs

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. 

Once your health plan has your new information, please give us a call so we can update our records, too.

Please ask your employer's benefits department for directions and the proper forms. 

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. 

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.

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. 

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. 

You will be responsible for the appropriate emergency copay.

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."* 

To learn more about Medicare and to sign up, you can make an appointment at your local Social Security Administration (SSA) office. 

Other ways to get information about Medicare are:

• Call SSA at 1-800-772-1213. Or visit ssa.gov.
• Call Medicare at 1-800-MEDICARE (TTY 1-877-486-2048), 24 hours a day, 7 days a week. Or visit medicare.gov.

Once you've signed up for Medicare, we can help you with your plan choices. We work with health insurance agencies who can help answer your questions about Medicare. We accept most Medicare plans. 

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.

* https://www.ssa.gov/benefits/medicare/

You can find your primary care doctor's phone number on your health insurance card. Or, you may call customer service at:

1-619-543-8800, choose option 3
Mon.–Fri.: 8 a.m.–5 p.m. PT, except holidays

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. 

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 here.

 

To change your primary care doctor, call your health plan. The plan will make the change, and tell the medical group about the change.

To find out, please call customer service at:

1-619-543-8800, choose option 3
Mon.–Fri.: 8 a.m.–5 p.m. PT, except holidays

 

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.

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.

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
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.

Appeal
If your doctor has requested services for you and you don't agree, you have the right to file an appeal.

How to file
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.

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:

1-800-956-8000, TTY 711
Mon.–Fri.: 8:30 a.m.–5 p.m. PT, except holidays

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.

Please note: We must follow provider confidentiality law. This means we are unable to tell members about grievance outcomes.

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.

If you have an individual or family plan, use this form.

If you have a Medicare plan, use this form.

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

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. 

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. 

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.

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 here. Or, call customer service and ask us to mail it to you.

Please be sure to sign the form. We can't accept PHI forms without your signature.

Mail the completed and signed form to:

Optum Care Network
Attn: Customer Service – online
P.O. Box 6902
Rancho Cucamonga, CA 91729-6902

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.

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 Optum Care Network’s Customer Service department.

If you have questions about a bill, please call customer service at:

 

1-800-956-8000, TTY 711
Mon.–Fri.: 8:30 a.m.–5:00 p.m. PT, except holidays

 

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:

 

1-800-956-8000, TTY 711
Mon.–Fri.: 8:30 a.m.–5:00 p.m. PT, except holidays

 

To get an authorization, ask your primary care doctor to send the request to the medical group.

To get the status of your authorization, you need to call your primary care doctor.

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.