FAQs

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

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

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

A newborn who qualifies 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. Ask your health plan 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 paying the ER copay.

When you turn 65, you can sign up for Medicare. The Social Security Administration (SSA) advises people to sign up for Medicare three months before turning 65. 

To learn more about Medicare and to sign up, 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.

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

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

Call your primary care doctor first and ask if they can see you. If your doctor can't see you, he or she will direct you to an urgent care center near you. 

If it's after hours, the office voicemail will give you directions. You can also find a list of urgent care locations here.

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

To find out, please call customer service: 

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

If your doctor leaves the network, someone from your health plan will contact you and help you choose a new doctor in your network. You can also find a doctor in your network by calling your health plan or visiting its 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 some examples of how 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 number is listed 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 your concern is heard and taken care of. 

You can also call customer service at:

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

We will be happy to document and send your concern to our quality department. They will review it and find out 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 how complaints are taken care of.

You can find the health insurance plan appeal and grievance form for an individual or family plan here. The appeal and grievance form for Medicare plans is here.

Fill out the form and sent it to your health insurance plan. The forms include the address, phone number and fax number for your health insurance plan.

We understand that health information about you and your health is personal. And we are committed to protecting it.

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

Because of this, 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. Or call customer service and ask them 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. If you have questions about your health information, please call your doctor.

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., except holidays

To learn about copays, please call your health plan. The phone number is on your insurance card. If you can’t find that 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., except holidays

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

To check on the status of your authorization, call your primary care doctor.

Call your insurance company. They will review your denied authorization and either overturn or uphold the decision.