Frequently asked questions

The right place to get care depends on your situation. Here’s how to get the care you need, at the right time and in the right place.

Urgent care 

Go to urgent care if you have a minor problem that can’t wait until the next business day. For example: 

• Stomach pain 
• High fever 
• Sore throat or ear aches 
• Minor cuts, skin infections and rashes 
• Minor fractures, broken bones 

911 or the ER 

Call 911 or go to the ER if you have: 

• Trouble breathing 
• Heavy bleeding 
• Chest pain 
• Sudden weakness, or have trouble talking 
• Severe head injuries 
• Major burns 
• Sudden allergic reaction 

If you’re not sure if you should go to the ER or urgent care, call your health plan’s nurse advice line. You can find the number on your health plan member ID card. 

To find an urgent care location:

• Use our provider look-up tool 
• Visit the Android™ or Apple^® app stores and download the Monarch CareFinder app.
• Call:
  Monarch Customer Service  
  1-888-767-2222 (TTY/TTD 800-735-2922)
  Mon.‒Fri. 8:30 a.m.–5 p.m. local time

Monarch HealthCare, part of OptumCare^® is a network of doctors, specialists and hospitals that provide your care. When you join an HMO, you must pick a network and a primary care doctor who belongs to that network. 

We are not an insurance plan but we work with plans to coordinate your care.

Monarch works closely with your doctor so you can get the most out of your health plan benefits.

Services include: 

• Personalized, coordinated care. Our health care professionals work closely with your doctor. We make sure everyone understands your care needs — specialists, the hospital, skilled nursing providers, physical therapists and others. We want to make sure you get the care you need from the right place and source.
• Programs for those with chronic conditions such as heart disease, chronic obstructive pulmonary disease (COPD), diabetes and end stage renal disease (ESRD).
• Medicare education for those turning 65. Speak to a Monarch senior ambassador, attend a class or get a referral to a licensed agent.

Please give your new information to your health plan. If you are working, please give it to your employer too. This information will be sent to us from your plan.

For CalOptima (Medi-Cal) members, we can help you with a name or address change. Please give us a call at:

Monarch Customer Service
Toll-free 1-888-767-2222 (TTY/TTD 800-735-2922)
Mon.‒Fri. 8:30 a.m.–5 p.m. local time

In order to make the change, we’ll need to ask you some questions. Your plan member ID number is one of the questions. Please have your card on hand when you call. 

Please get medical help by calling 911 or going to the nearest emergency room (ER). You should always see your primary care doctor after an ER visit or hospitalization.

To change your primary care doctor, call your health plan’s member services department. The number is on your plan identification card. You may change your doctor as often as once a month. 

If you are a CalOptima (Medi-Cal) member, we can help you change your doctor. Please give us a call. You can reach us at:

Monarch Customer Service
Toll-free 1-888-767-2222 (TTY/TTD 800-735-2922)
Mon.‒Fri., 8:30 a.m.–5 p.m. local time

In order to make the change, we’ll need to ask you some questions. Your plan member ID number is one of the questions. Please have your card on hand when you call. 

If you have a certain specialist you wish to use, please talk to your primary care provider (PCP). Your doctor will recommend a specialist based on your medical condition. The choice will also depend on your health plan. If you have a question about specialists in our network, please call:

Monarch Customer Service
1-888-767-2222 (TTY 800-735-2922) 
Mon.‒Fri., 8:30 a.m.–5 p.m. 
Hours vary during holidays.

For your correct copay or benefits, please call your health plan. The phone number is on your plan member ID card. If you can’t find the phone number, we can help. Please call:

Monarch Customer Service
1-888-767-2222 (TTY 800-735-2922) 
Mon.‒Fri., 8:30 a.m.–5 p.m.
Hours vary during holidays.

Please call Monarch Customer Service at:

1-888-767-2222 (TTY 800-735-2922) 
Mon.‒Fri., 8:30 a.m.–5 p.m.
Hours vary during holidays.

We’ll do our best to help you. If it’s after hours and you leave a message, please allow us time to reach you the next business day.

You have a right to file an appeal or grievance with your health plan if:

• You’re unhappy with your medical care or service, or 
• You disagree with the service your doctor has requested

How to file an appeal or grievance

To file, please call your health plan. You can find the phone number on your health plan ID card. Your plan will give you instructions. Please stay in contact with your plan so you can stay informed about results. By law, we can’t give you details about the results.

To appeal a denied authorization or referral, call your health plan. The health plan will review your denied authorization and either overturn or uphold the decision.

To get an update on the status, contact your primary care doctor. Or call Monarch Customer Service at:

1-888-767-2222 (TTY/TTD 800-735-2922)
Mon.–Fri., 8:30 a.m.–5 p.m., local time
Hours vary during holidays.

We understand that medical information about you and your health is personal. We’re committed to protecting medical information about you. Your medical information is protected by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). 

According to HIPAA, we must confirm that you are a member with our medical group. To do so, 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 for details.

If you need a friend or relative to speak on your behalf, you will need to complete a disclosure of protected health information form. (If you can’t download the form, call Monarch Customer Service and ask us to mail it to you.)

Please be sure to sign the form. We can't accept it without your signature.

Mail the completed and signed form to:

Monarch HealthCare
Attn: Business Operations - MS 11
11 Technology, Irvine CA 92618

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. Please call your doctor for your medical information.

Maybe you’re still working or you have a health plan through your pension or veteran’s service. You don’t need to go on Medicare, but you need to let Medicare know. Otherwise you may face higher costs if you sign up for Medicare in the future.

If you’re thinking about Medicare you may want to look at other choices, like Medicare Advantage. Medicare Advantage plans cover everything that Original Medicare does. Some plans offer more, like prescription drugs, dental, hearing and vision.  And Medicare Advantage plans may cost less than an employer’s plan.

If you have questions about a bill or are unsure why you received one, please call:

Monarch Customer Service
1-888-767-2222 (TTY/TTD 800-735-2922)
Mon.–Fri., 8:30 a.m.–5 p.m., local time
Hours vary during holidays.

In order to better serve you, we may ask for a copy of the bill including the name of the business that sent it to you.