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Patient Information

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Frequently Asked Questions

Membership frequently asked questions

Q: How do I contact Prospect Medical Group?

If you are a Prospect Medical member or would like to become one, please call our Customer Services at (800) 708-3230 for questions or assistance. We have representatives available weekdays between the hours of 8 a.m. and 5 p.m. Bilingual representatives are available to assist you. You can also email us.

For individuals who are Medicare eligible, we also have our Seniors VIP Line at (877) 619-5900, where bilingual representatives are available to assist you, or email us.

Q: How does Prospect Medical Group work with my health plan to provide my care?

Prospect Medical Group contracts with your health plan to provide the primary care providers (PCP) in our extensive network. The PCP you select works with you and Prospect Medical 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!

Q: How do I pick a primary care provider?

Prospect Medical's extensive network of primary care providers means that you can select a PCP close to your home or work. Here are steps you can take in selecting your primary care provider.

  • Go to our physician finder
  • Select your provider by name, geographic location or specialty (many of our providers have special training and skills, such as speaking multiple languages)
  • You can call the physician to make an appointment and obtain provider identification number to submit to your health plan to get you on board
  • We can also assist you in choosing a PCP and scheduling an appointment with your primary care provider by calling (800) 708-3230 or email us
  • For individuals who are Medicare eligible, we also have our Seniors VIP Line at (877) 619-5900, where bilingual representatives are available to assist you, or email us
Q: How does the Customer Service and Member Relations team help me get the care and services I need?

We’re here to make your health care experience as simple and convenient as possible. From helping you understand your benefits to finding the right doctor, taking care of your health and wellness starts with our team. With one call to (800) 708-3230 or to the Seniors VIP Line at (877) 619-5900—we can help you do the following:

  • Find a primary care provider (PCP), urgent care center, laboratory and pharmacy locations
  • Change PCPs
  • 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

Insurance frequently asked questions

Q: Where do I call if I have a question about my bill?

If you have questions regarding your statement, our billing staff is available to assist you with questions related to your account. You can contact our patient services office by calling (844) 523-5126 between the hours of 8 a.m.-5 p.m, Monday through Friday, excluding holidays, or email us.

Q: What’s the difference between a co-payment and premium?

A co-payment is what you pay your PCP for services received and goes directly to the PCP. The co-payment amount is a set by your health plan. A premium is what you pay for your health coverage and is usually paid monthly. This goes directly to the health plan.

Q: How do I file a grievance or appeal any decision?

All members of Prospect Medical Group have the right to file a grievance or appeal any decision. It’s important to understand the difference:

  • A grievance is a written or verbal expression of a member’s dissatisfaction with the care or services provided, and may be used to request review of a complaint or inquiry that has not been resolved to the member’s satisfaction.
  • A complaint (or inquiry) is a member’s written or verbal request for information or assistance, or an expression of concern about an issue. A complaint can become a grievance.
  • An appeal is a written or verbal request to reconsider the initial determination of a denied healthcare service or claim.

Patient Care frequently asked questions

Q: What do I do if I have an emergency?

If you have an emergency call 911 or go to the nearest emergency room (ER). The need for emergency care is defined as an illness or injury that a reasonable layperson feels puts him or her in danger or could be seriously harmed. These include broken bones, severe chest pain, severe burns, fainting, drug overdose, severe bleeding and psychiatric emergency conditions.

Q: How do I contact Prospect Medical Group?

If you are a Prospect Medical member or would like to become one, please call our Customer Services at (800) 708-3230 for questions or assistance. We have representatives available weekdays between the hours of 8 a.m. and 5 p.m. Bilingual representatives are available to assist you. You can also email us.

For individuals who are Medicare eligible, we also have our Seniors VIP Line at (877) 619-5900, where bilingual representatives are available to assist you, or email us.

Q: Why should I schedule an initial appointment with my selected primary care provider?

Scheduling your first doctor’s appointment is the best way for us to help you manage your healthcare needs and wellness goals. Even if you’re feeling good, scheduling regular doctor’s visits and establishing a relationship with your doctor is the best way to stay healthy.

Your first appointment is a checkup that includes a blood analysis, a review of your medicines and medical history. If you’re moving from another health plan, this is where we can make sure we continue the existing services and programs important to your health. You will leave your visit with a personal plan of care. This will give you the peace of mind that you and your doctor have a plan to meet your needs and goals.

Q: What do I do if I need transportation to my appointments?

Prospect Medical will coordinate transportation for you. To arrange for transportation, call at least 48 hour prior to appointment (800) 708-3230 and Medicare-eligible members should call (877) 619-5900.

Q: How and where do I get my prescriptions?

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. You customer service team can sign you up. Prospect’s preferred pharmacies include CVS, Walgreens, Rite Aid, Target, Walmart and many others in our network.

Q: Where should I go for care if my primary care physician’s office is not open?

If you are experiencing an emergency or life-threatening condition, please call 911 or go to the nearest emergency room.

Prospect provides urgent care services for non-life-threatening emergencies that occur outside of normal doctor office hours. Urgent medical conditions are ones that are not considered emergencies, but still require care within 24 hours. Some examples include, sore throat or earaches, fever, minor injuries or lacerations, minor fractures or broken bones, allergic reactions and sports injuries.

You can also call your health plan as they often offer 24-hour nurse consultation lines that can advise you whether to go to an urgent care center or wait until your doctor’s office reopens.

Q: Where do I call if I have a question about my bill?

If you have questions regarding your statement, our billing staff is available to assist you with questions related to your account. You can contact our patient services office by calling (844) 523-5126 between the hours of 8 a.m.-5 p.m, Monday through Friday, excluding holidays, or email us.

Q: How do I pick a primary care provider?

Prospect Medical's extensive network of primary care providers means that you can select a PCP close to your home or work. Here are steps you can take in selecting your primary care provider.

  • Go to our physician finder
  • Select your provider by name, geographic location or specialty (many of our providers have special training and skills, such as speaking multiple languages)
  • You can call the physician to make an appointment and obtain provider identification number to submit to your health plan to get you on board
  • We can also assist you in choosing a PCP and scheduling an appointment with your primary care provider by calling (800) 708-3230 or email us
  • For individuals who are Medicare eligible, we also have our Seniors VIP Line at (877) 619-5900, where bilingual representatives are available to assist you, or email us
View All Patient Care FAQ'sView Less

Referrals frequently asked questions

Q: How do I get a referral to a specialist and how long does the authorization process take?

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 for approval. Here’s how it works:

  • Most referrals or requests are received back within five business days and many can be approved the same day
  • If you have a question about a referral or the status of an authorization request, contact your PCP’s office, or call Prospect’s Customer Service Team at (800)708-3230 or email us.
Q: What do I do if I feel a referral to a specialist is urgent?

Your PCP may request a STAT/URGENT authorization request by contacting our Prospect’s Utilization Management to discuss the medical urgency of the request. STAT/URGENT authorization requests are processed within 24-48 hours.

Q: Do I have the option to change the specialist or facility I am being referred to?

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 contact the following:

  • Members can contact our bilingual Customer Service Team at (800)708-3230 or email us
  • For individuals who are Medicare-eligible, you can email us or call one of our bilingual representatives on our Seniors VIP Line at (877) 619-5900
  • Visit our Complaints and/or grievances page for more information on how to file a complaint or appeal. Should the grievance be forwarded directly to Prospect Medical, it will be reviewed by our Quality Team for resolution, and forwarded to the appropriate health plan.

We’re here to give you the support you need and help you make the best choices for your care.

Questions?
(800) 708-3230