What insurance plans do you accept?
Current Health Plans
- Aetna Senior (AETS)
- Blue Cross Senior Secure (CALS)
- Blue Shield Promise (Formally Care I’S) (BSPS)
- Blue Shield 65 (BL65)
- Alignment Health Plan (aka Citizens Choice) (CZCH)
- Easy Choice Health Plan aka Wellcare (ECEP)
- Health Net MediConnect cm-I
- Health Net Seniority Plus (HNSP)
- Humana Senior (HUMS)
- Humana Medi-Medi (HUNN)
- LA Care MediConnect (LA-I)
- Molina MediConnect (MO-D)
- SCAN Health Plan (SCAN)
- SCAN Independent Living Power (SLP)
- SCAN Medi-Medi (9 FEM)
- Secure Horizons/United Healthcare (SECH)
- Aetna POS (AETP)
- Blue Cross Plus (BCPL)
- Blue Shield POS (BLSP)
- Cigna Commercial POS (CIGP)
- Health NetSharedRisk/POS (m.1EP)
Medi-cal Plans: existing Patients
- Health Net Medi-C (1 NML, mqSL)
- Health Net Medi-Cal Expansion (HNEE, ms 1SE)
- LA Care Medi-Cal (LAN/IL, LASL)
- LA Care Medi-Cal Expansion (LAEE)
What is a Medical Group?
- A medical group is a group of doctors, nurses, specialists, and other professionals dedicated to patient healthcare. Medical groups work with health plans to coordinate both care and coverage for each individual.
- The job of a health plan and it’s contracted medical group can vary depending upon the type of health plan. For instance, in a PPO plan, the doctor and medical group’s main responsibility is to care for patients at the time of the appointment; the patient is responsible for coordinating care. In an HMO plan, the doctor and medical group often have a bigger job than just providing immediate patient care; with an HMO, they are pro-actively working to improve the patient’s overall health – including steps to avoid future health problems; this is called preventive care.
What is the process if I need to see a Specialist or require special (durable) medical equipment? (Oxygen, wheelchair, cane, etc.)
- If your Primary Care Physician determines that you need to be seen by a Specialist or need durable medical equipment, he/she will submit a referral to HDMG’s Utilization Management Department. The Utilization Management committee will review the referral by applying established criteria, determine medical necessity, and ensure that any tests needed have been completed.
- If your physician requests an urgent referral, it will be processed within 72 hours. For non-urgent requests, you will be notified of the determination within seven business days. If the referral is modified, you will be notified of the modification, along with further information and instructions. If the referral is denied, notification will be mailed to you, along with the appeal process.
- You have the right to appeal a denied or modified referral; you may begin your appeal by contacting your insurance company.
- Your Primary Care Physician will be notified of the status of your referral also.
How does my new physician obtain a copy of my medical records?
- You will need to complete and sign a Medical Record Release form. You may obtain the form at either HMG or at your previous physician’s office. Once the form is completed, your medical records will be sent to your new physician’s office or group.
How do I follow up on a referral if it has been longer than the allotted time?
- If you have not been notified regarding the status of your referral within seven business days, please contact your Primary Care Physician.
How do I access my medical records as an HMG Health patient?
- As an HMG Health patient, you may enroll in our online service “NextGen Patient Portal”. This website provides patients with an easy-to-use internet portal to communicate with your physician, request appointments, request a prescription refill and more.
- The Patient Portal is secure, confidential, and gives you 24-hour access to your medical records.
What is a Medicare Advantage Plan?
- A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare (a government plan) to provide you with all your benefits (Part A and in most cases, Part B). Medicare Advantage Plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans.
- If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and are not paid for by Medicare. Most Medicare Advantage Plans offer prescription drug coverage.