FAQs

Please give your new information to your health insurance plan and your employer. Your health insurance plan checks with your employer to make sure you're eligible. Because of this, it's important that both have the most current information.

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

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

A newborn who's eligible under your plan is usually covered for 31 days from the date of birth. To cover your child after that, you need to enroll them 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 insurance company for details.

Get 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. They should make sure you get all of your follow-up care.

You are responsible for the ER copay.

You can sign up for Medicare when you turn 65. There is a seven-month enrollment period. The Social Security Administration (SSA) advises signing up three months before you turn 65.*

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

Other ways to get information about Medicare:

• 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, seven 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/

Your primary care doctor's phone number is listed on your health insurance card. You can also call customer service:

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

To get the right urgent care, call your primary care doctor first and ask if they can see you. If that's not possible, your doctor will direct you to the correct urgent care.

If it's after hours, the office voicemail will give you directions to follow. You can also get this information by calling customer service:

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

To change your primary care doctor, call your health plan. Someone at the plan will make the change and give us the name of your new doctor. 

To find out, please call customer service at:

1-800-956-8000, TTY 711
Mon.–Fri.: 8:30 a.m.–5:00 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 doctor who's in your network, you can also call your health plan or visit their website.

Optum, formerly NAMM California (North American Medical Management California, Inc.), works with your health plan to manage your health care.

Your feedback is important to us. Our goal is to offer you the best possible service.

Here are examples of how and when to share a concern. 

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. The phone number is listed on your health plan ID card.

We want you to be happy with your care. Send your appeals, complaints and grievances to your health plan. We will work closely with your health plan to make sure your concern is heard and taken care of. In addition, you can call customer service at:

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

We will also be happy to document and send your concern to our quality department. They will look at and decide how we can improve our service. Remember, to file a formal grievance, you must contact your health plan directly. 

Please note: We must follow provider confidentiality laws. This means we can't 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 your health information is personal. That's why we protect it.

Your medical information is protected by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). According to HIPAA, we must make sure that you are a member of our medical group.

That's why 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. Download the form or contact us and ask to have the form mailed to you. 

Please be sure to sign the form. We can't accept forms with protected health information 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 contact 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

To learn about your copay or health care benefits, please call your health plan. The phone number is on your insurance card. If you can’t find the number, call customer service at:

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

Your doctor's office will get in touch with your health plan if you need approval for a medical test or service. 

Call your doctor's office to find out if your health insurance company has authorized a test or service.

To appeal a denied authorization or referral, call your insurance company. They will review the situation and either overturn or uphold the decision.