Accessing Care FAQs

MemorialCare Medical Group is an open network, which means you can see any primary care physician or physician assistant in any of our offices. We do, however, recommend that you select one physician or physician assistant as your primary provider. This gives you the benefit of having one provider who knows you and your medical history, and who can coordinate all aspects of your health care needs.

Physician assistants are health care professionals licensed to diagnose and treat medical problems including conducting physical exams, ordering and interpreting tests, providing preventive health information, assisting in surgical procedures and prescribing medications. MemorialCare Medical Group physician assistants are supervised by a physician.

You can request to be seen by a physician assistant when making your appointment. You may also be seen by one depending on the availability of physicians, and the nature of the illness or condition.

The goal of the referral process is to ensure patients are provided an appropriate level of care and:

• Authorized quality care is offered in a timely manner.
• Authorized care matches the benefits defined by the patient's health plan.
• Services are medically necessary and are delivered at appropriate levels of care.
• Guidelines and standards of medical practice criteria set by governmental and other regulatory agencies are adhered to as appropriate.
• Utilization Criteria available upon request.

When in doubt, check with the Referral Coordinator at your MemorialCare Medical Group office.

You will be referred to a physician specialist or other health care provider when you need care that your primary care physician cannot provide.

If you are a HMO patient, many referrals to a specialist can be authorized directly by your primary care physician during your office visit.

If you are a PPO patient, contact your insurance plan to verify that services such as referral to a specialist, a surgical procedure or diagnostic testing are covered by your health plan. Inquire which primary care physicians, specialists and places of service are considered preferred providers to reduce your out-of-pocket expense.

We have an extensive referral network that includes qualified professionals in almost every specialty. The specialists with whom we contract are carefully chosen and work closely with your physician to provide the care you need.

If you are interested in a particular specialist, please discuss this with your MemorialCare Medical Group physician. There are many factors involved in the decision of which specialist you will be referred to, including the specialist's hospital admitting privileges, area of expertise, schedule, and patient preference.

We have staff available eight hours a day during normal business hours to answer your questions regarding our utilization management process or the criteria we use when making our decision, or any question you may have regarding a referral. Just call our Navigation Center at (877) 696-3622. We will accept collect calls when the call relates specifically to a utilization management issue.

MemorialCare Medical Group’s physicians and health care professionals make utilization management decisions based on the appropriateness of care and services for patients’ medical needs and existence of coverage.  MemorialCare Medical Group’s compensation system is designed to reward physicians for their personal hard work and the quality of services they provide.  We do not reward any individual for denying coverage or service, nor do we use financial incentives to encourage inappropriate utilization.

The materials provided to you are guidelines used by this plan to authorize, modify, or deny care for persons with similar illnesses or conditions. Specific care and treatment may vary depending on individual need and the benefits covered under your contract.

MemorialCare Medical Foundation utilizes the Care Guidelines to determine medical necessity for the plans that we manage. The Guidelines are the protected intellectual property of MCG. MemorialCare Medical Foundation is not able to distribute them without the permission of MCG. MCG has provided a tool that allows MemorialCare Medical Foundation members and prospective members to view relevant MCG guidelines, however you will not be able to print them. 

Follow the instructions below to access the MCG Guidelines: 

Step 1: Access guidelines here, read the disclaimer, and accept the terms and conditions. 
Step 2: Complete the User information form. 
Step 3: Complete the verification process to continue. 
Step 4: Click on the arrow icon. 
Step 5: Click on the guidelines you wish to view.

You may submit your request for a referral by leaving a message with your provider or through our secure web based patient portal. Depending on the type of referral, your provider may require you to schedule a visit.

A sign language interpreter may be arranged should you need one during your office visit. Kindly give us a 72 hour advance notice. For telephone communication, patients may utilize California Relay Voice Line (TDD/TTY) by dialing 711 or (800) 735-2929 or (800) 735-2922.

Through MemorialCare Medical Group's well woman services, you can access an OB/GYN from our list of contracted providers for your annual Pap Smear without a referral. Please contact the patient service representative at your MemorialCare Medical Group office for a list of designated providers.

However, if your results come back abnormal and you need to be seen again, you will need to see your primary care physician for follow up care. If you need additional care in which your primary care physician cannot provide, he or she will refer you to an OB/GYN.

For a condition needing prompt attention, you can access one of the Urgent Care Centers.
Urgent Care Locations & Hours

If you need medical attention after the Urgent Care Centers close, call your MemorialCare Medical Group office and the phones will ring to the Advice Nurse Line on duty. A registered nurse will work with you to answer questions and assess your immediate medical needs. A MemorialCare Medical Group physician is always available to the Advice Nurse Line for situations requiring a physician's expertise.

Urgent care is defined as an injury or condition needing prompt medical attention, but not life-threatening.
Urgent Care Locations & Hours

You should seek emergency care at the closest hospital emergency room if you experience an injury or condition that could permanently endanger your health if not immediately treated. Call 9-1-1 immediately or go to the nearest hospital emergency room. Notify your primary care physician as soon as possible.

We have a team of physicians dedicated solely to caring for patients while they are in the hospital. The team is responsible for directing the care of our patients, including arranging specialty care consultations, ordering diagnostic tests and keeping the primary care physician updated on important developments and plans for care after discharge.

The fastest way to refill your prescription is to call your pharmacy directly. Most Prescriptions can be refilled within three business days if you call your pharmacy with your prescription number and the name and phone number of your physician.

But don't wait until your prescription runs out. Plan and call before you reach the end of your medication.

Most health plans have provisions for illness and injuries that occur away from home. Contact your health plan for more information.

Once you return home, contact your primary care physician to let him or her know what happened. He or she can help you determine if follow-up care is necessary.

MemorialCare Medical Group physicians are committed to partnering with you in maintaining good health. As a patient, you have the right to:

1. Be treated with professionalism, respect, courtesy and dignity.
2. Have all matters considered private and confidential within the limitations of the law.
3. Participate in decisions about your health care and treatment, as well as receive adequate information about your diagnosis and proposed treatment plan from your health care provider in order to give informed consent.
4. Refuse any procedure or treatment if you so desire and be told what effect this may have on your health.
5. Have 24-hour access to a primary care provider or substitute within reason. Problems not resolved on the telephone may be referred to our Urgent Care Centers. Some emergencies may be referred to a local emergency room facilities by a physician when the problem cannot be resolved by the above methods.
6. Receive complete information about our fees. The service fees are available by calling (714) 665-1770.
7. Be informed of the procedure we have for grievances, complaints or other conflicts, as we take these very seriously. We recognize listening improves your best care and helps us to improve our services.
8. Receive medical services regardless of age, sex, race, color, religion, ancestry, national origin, disability or sexual orientation.

MemorialCare Medical Group physicians are committed to partnering with you in maintaining your good health. As a patient, you have a responsibility to:

1. Provide your health care provider with complete and accurate information.
2. Follow the treatment plan agreed upon by you and your physicians, with the understanding that your primary care physician should provide the care he or she is trained to provide prior to any referral to a specialist.
3. Know the benefits, limitations and exclusions of your insurance coverage.
4. Pay for services rendered, including co-payments and deductibles.
5. Understand that before any specialty care may be obtained, you must receive a referral from your primary care physician, if required by your insurance company.
6. Contact your primary care physician or available provider for health care questions or care needed after hours.
7. Know how to access health care services in routine, urgent and emergency situations. An emergency is a serious condition requiring immediate intervention. An urgent condition could either lead to a potentially harmful outcome if not treated or require immediate attention (within 24 hours) due to the severity of the symptoms. A non-urgent condition includes a limited physical exam for follow up of acute or chronic medical or surgical conditions.
8. Regard health care providers and staff with courtesy, attend scheduled appointments or thoughtfully cancel an appointment with as much notice as possible so that other patients can utilize that time.

We offer a variety of education classes including screenings and one-on-one education, both within MemorialCare Medical Group and in cooperation with our partner hospitals. Many programs are free-of-charge and are designed to help you take charge of all aspects of your health. For health education information, call (714) 665-1701.