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Member information

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The information contained on this page is provided on behalf of North American Medical Management California, Inc., part of OptumCare® (NAMM California) and the Independent Physician Associations (IPAs) it manages. 

The topics are provided as an overview and for informational use only. Contact your IPA's Customer Service for more information.

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Care coordination

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  • To obtain further information about the hospitals and physicians that are participating with your IPA, please visit the Affiliated medical groups page.

     

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  • Timely access to care will result in swift problem identification, follow-ups on previously identified issues and appropriate use of health care resources. NAMM California's managed IPAs and Medical Groups have established the following standards for access to care.

    • Our business model encourages and rewards physician participation at all levels of the organization to meet common goals. 

    Access to routine care:

    • Telephone calls will be answered in a timely manner.
    • Answering service available for 24/7 support.
    • The physician on call will respond within 30 minutes of an urgent call.
    • Average wait time in the office won’t exceed 15 minutes from arrival time.

    Non-urgent appointments:

    • Well visits or new patient appointments available within 30 days of call
    • Non-urgent care appointments within 10 business days of call
    • Non-urgent specialty consultation appointments available within 15 business days of call

    Urgent appointments:

    • Urgent appointments that do not require prior authorization available within 48 hours of request
    • Urgent appointments that do require prior authorization available within 96 hours of request

     

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  • When a member's active care may be disrupted by the departure of a specialty physician from the network, the member will be notified 60 days prior. The member can call Customer Service for a list of suitable providers for ongoing care. 

    For members with special transition concerns, case managers will work with the member and physician(s) to develop a continuity of care plan.

     

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  • The delivery of health care depends on a mutual partnership between a member and their primary care physician. Members have certain rights and responsibilities that are important to know and understand. 

    View the NAMM member rights and responsibilities in English or in Spanish.

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Extra layer of care and support

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  • NAMM California's managed IPAs base decisions regarding the provision of service on the patient's clinical condition, community standards of care and the patient's health benefit plan. 

    Decisions are not based upon physician incentive packages, reimbursement levels or other considerations.

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  • We strive to provide the best service for you and are interested in your feedback. You can submit your comments to your IPA's Customer Service

    If you need to file a complaint or grievance, please contact your health plan at the number listed on your ID card.

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  • NAMM California's managed IPAs do not base the provision of care on ethnicity, gender, sexual orientation, race, mental or physical disability. The provision of care is based only on appropriateness of care and service and existence of coverage. 

    We do not specifically reward practitioners or other individuals for issuing denials of care. Financial incentives for Utilization Management (UM) decision makers do not encourage decisions that result in underutilization. 

    Decisions regarding hiring, compensation, termination, promotion or other similar matters with respect to any individual, are not made based upon the likelihood the individual will support the denial of benefits.

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  • Treating physicians will honor a member’s wishes as described in the advance directives. The presence of advance directives does not influence the availability or access to physicians, medical services or covered benefits. 

    The advance directives can be revoked at any time.  Click here for more information.

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  • Our primary care physician offices are evaluated to ensure accessibility by members who might have disabilities. There are several ways to support members who may have difficulty communicating with a health care provider.  

    For non-English speaking members, translation services are available to assist the member. To access these services, please contact your primary care physician.

    For sensory impaired members, staff can provide information to accommodate them. If a non-hearing member needs a sign interpreter, one will be made available. If you have a speech or hearing impairment and use TTY, please call 711. 

    For sight impaired members, staff will review any written information verbally. If a member has difficulty understanding, please contact your IPA's Customer Service.

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Helpful resources

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Affiliated medical groups

Learn more about the key affiliates of NAMM California.

Resources

Access important provider information in one location.

Contact us

Please contact us with your questions.