Welcome to the Prospect Medical Family
At Prospect Medical, our members’ health and well-being are our priority. Through our network of physicians, patients have access to all their healthcare needs—from preventive care to medical procedures. Our pledge is to give all our patients the personal attention needed to ensure they get the proper medical care as soon as possible and in the right setting—whether it’s in a doctor’s office, outpatient clinic, urgent care center, member’s home, or in a hospital.
Our network of physicians and healthcare facilities are held to the highest quality standards. You will receive the best care that we can provide. We promise we will be with you every step of the way.
How Prospect Medical Manages Your Care
Prospect contracts with your health plan to provide the primary care providers (PCPs) in our extensive network. The PCP you select works with you and Prospect to help coordinate your healthcare services.
We provide all your PCP’s support services, such as care management, referrals for specialists and outpatient services, medical supply requests, customer service and education services. This gives your doctor the freedom to do what he or she does best—take care of you!
As your Customer Service and Member Relations team, we are ready to help you get the most out of your health services. With one call our team can help you:
- Find a doctor, urgent care center, laboratory and pharmacy locations
- Make PCP changes
- Get a new membership card or replace a lost card
- Update new information such as address changes, phone numbers, etc.
- Schedule a ride to your doctor’s appointment
- Check on referral status
- Answer benefits-related and claims questions
- Address enrollment issues
Please email us or call us at (800) 708-3230 Monday-Friday, 8 a.m.to 8 p.m. For individuals who are Medicare-eligible, email us or call our bilingual representatives on our Seniors VIP Line at (877) 619-5900.
Referrals and Authorizations
Authorizations for specialties included in our Direct Referral program are authorized upon submission. For other specialties where authorization is needed for a referral or request, your PCP will send it to Prospect’s Utilization Management Department for approval.
Most referrals or requests are received back within five business days and many can be approved the same day. If your PCP feels the referral is urgent, he or she may request a STAT/URGENT authorization by contacting Prospect’s Utilization Management team to discuss the medical urgency of the request. STAT/URGENT authorization requests are processed within 24-48 hours.
Our referral network has been established to provide you the broadest range of quality specialists and facilities that best meet your needs. If you’re not satisfied with the specialists or facility you’ve been referred to, please email or contact us at (800) 708-3230. Bilingual phone representatives are available Monday through Friday, 8 a.m. to 8 p.m. PST.
Medicare-eligible members should call us at (877) 619-5900.
Our Customer Service and Member Relations team can help you in any language. We can arrange for on-site interpreters, including American Sign Language (ASL), to be scheduled during your doctor’s visit. Information in other languages are also available, including Braille, audio or large print. For language services, please call (800) 708-3230 Monday-Friday, 8 a.m.-8 p.m. or email us. For Medicare-eligible members, email or call us at (877) 619-5900.
Prospect Medical will coordinate transportation to get to your appointments. Contact our Customer Service team at least 48 hours in advance so we can coordinate this transportation service for you:
- Members call (800) 708-3230
- Medicare-eligible members call (877) 619-5900
Bilingual phone representatives are available Monday-Friday, 8 a.m.-8 p.m. to assist you with transportation.
For prescriptions and refills, ask your doctor to send your prescriptions to a Prospect network pharmacy. We also encourage you to get a 90-day supply of your prescriptions by mail order sent to your home.
Our goal is to help you get the care you need when you need it: Our bilingual phone representatives are available Monday-Friday from 8 a.m.-8 p.m.
Members can call (800) 708-3230 or email us and Medicare-eligible members should call our Senior VIP Line at (877) 619-5900 or email us.
Our mailing address is Prospect Medical, 600 City Parkway West, 10th floor, Orange, CA 92868.
We’re here to give you the support you need and help you make the best choices for your care.