Your primary care physician (PCP) coordinates all of your healthcare needs, including specialist referrals, tests and any other necessary services. When you signed up for your senior health plan, you were probably asked to select a PCP or one was assigned to you. It is important that you call your PCP for an appointment and have your medical records sent to him as soon as possible.

If for any reason you would like to change to another PCP, you may do so at any time throughout the year.

If you need to select a new PCP, one of our Customer Service representatives can refer you to another Monarch HealthCare provider who is accepting new patients and is part of your health plan. Also, please check our website at www.monarchhealthcare.com for a list of physicians. Then, you must call your health plan by the 10th of the month to make the change.

For Outpatient Referrals and Services
Specialist physicians, X-ray and rehabilitation service referrals are coordinated by your PCP. Most authorizations are approved within 24 to 48 hours. If you have questions about the status of a referral, please call your PCP or a Customer Service representative at (949) 923-3200, option 1 or toll free 1 (888) 767-2222, option 1.“In accordance with State and Federal regulations, please be aware that all Monarch HealthCare physicians’ decision-making processes are based upon appropriateness of care and Monarch HealthCare does not provide incentives to encourage denial of patient care.”

Disclosure of Utilization Management Policy and Procedures and Criteria for making decisions
"Upon request by a member, a person designated by the member, or by a member of the public, a copy of the requested material will be mailed to the requestor. The materials provided are guidelines used by Monarch HealthCare to authorize, modify or deny care for persons with similar illness or conditions. Specific care and treatment may vary depending on individual needs and the benefits covered under the individual's contract."

Where To Go For Laboratory Services
Your lab work may be performed at any one of the LabCorp draw station offices located throughout Orange County.

If You Need Medical Equipment or Supplies
Your PCP will submit a referral if you need medical equipment such as wheelchairs, walkers, oxygen or diabetic supplies. After it is authorized, you will be directed to the appropriate contracted provider to obtain the requested item.

About Prescription Medications
For questions and concerns regarding your prescriptions, please call your health plan or refer to your prescription drug formulary.

Urgent Care or After-Hours Minor Emergencies
Monarch HealthCare provides urgent care services for minor medical emergencies that occur after regular office hours. For your convenience, a list of Urgent Care Centers is included.

In An Emergency
In case of emergency, please call 911 or go to the nearest hospital emergency room.

If You Require Hospital Care
When Monarch HealthCare patients are admitted to the hospital, they are assigned to a “hospitalist” physician. A hospitalist is usually an internist with sub-specialty medical training in pulmonary diseases or critical care medicine. The hospitalist will work with your PCP from admission to discharge. The hospitalist will also coordinate your care with other specialists as needed.

Additional Questions
If you have any questions about doctors or referrals, please call Monarch HealthCare Customer Service at (949) 923-3200 or toll free at (888) 767-2222. You may also visit our website at www.monarchhealthcare.com

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