TO USE THE NETWORK
Pomona Valley Medical Group Inc. is a leading provider of health care services
comprised of highly qualified physicians who are in individual
private practices or medical groups. Pomona Valley Medical Group Inc.
is supported by an experienced administrative management company,
ProMed Health Care Administrators (ProMed HCA), who understands
the HMO/Managed Care system. ProMed HCA is staffed with qualified
health professionals who are available to answer your questions
regarding the Network doctors and services. Your Primary Care
Physician (PCP), often referred to as your "family doctor",
is responsible for managing and coordinating your medical
care. Pomona Valley Medical Group Inc.'s physicians are Board Certified
or Board Eligible in the areas of Family Practice, General
Practice, Internal Medicine, or Pediatrics. The Pomona Valley Medical Group Inc. Primary Care Physician you choose will coordinate
all of your health care needs including routine office visits,
physicals, referral to specialists, and authorizations of
emergency care. If you recently selected a Pomona Valley Medical Group Inc.
doctor you may call the office to schedule an appointment.
In order to ensure you receive the best possible treatment,
be sure to tell your doctor everything you can about your
symptoms, any medications you are taking, and ask any necessary
questions about your treatment options. If you are over 18,
you must select either a Family Practice, General Practice,
or Internal Medicine physician. Most Family Practice physicians
will also treat pediatric patients.
HOURS OF OPERATION
ProMed office is open 8:00 AM - 5:00 PM, Monday thru Friday
PVMG telephone number is : (909) 932 1045
The ProMed 800 (toll free ) number is: (800) 281-8886
office is closed on the following holidays:
Year's Eve Day
1/2 day New Year's Day
day Christmas Day
staff, including UM personnel, are available during normal
hours of operation.
HOURS STAFF AVAILABILITY
normal business hours, members, vendors and/or providers can
contact the IPA for urgent or emergent medical issues . They
are to call the normal business telephone number and can follow
the instructions to reach the on call nurse for assistance.
Business hours: ProMed can provide telephone translation services
with staff or ATT Language line
HCA and their affiliated IPAs do not engage in economic credentialing
or in promoting penalties on physicians who provide quality
health care and service. Any compensation plans do not include
incentives for inappropriate review decision. (NCQA UM 13)
HCA provides access to staff for members and practitioners
seeking information about the UM process and the authorization
of care. The following communication services are provided
for practitioners and members;
of staff at least 8 hours a day during normal business hours/days
for inbound calls regarding UM issues. ProMed HCA accomplishes
this via telephone, fax and/or electronic mail during normal
of staff to receive inbound communication after normal business
hours regarding UM issues. After regular business hours,
members and/or providers are directed to the case manager,
a licensed health care professional, who is on call via
the ProMed HCA answering exchange.
communication from staff regarding inquiries about UM during
normal business hours, unless otherwise agreed upon. ProMed
HCA accomplishes this via telephone, fax and/or electronic
mail during normal business hours.
identifies themselves by name, title and organization name
when initiating or returning calls regarding UM issues
toll free number or staff that accept collect calls regarding
UM issues. ProMed HCA maintains a toll free number. This
is available to members via the new member letter and on
the ProMed HCA website . Providers can also access the ProMed
HCA website for this information
to staff for callers with questions about the UM process.
Methods of access are as indicated above.
ProMed HCA Internet website contains this information regarding
ProMed HCA access for members and practitioners seeking
information about the UM process and the authorization of
care. The website information includes location, telephone
number, toll free telephone number, hours and days of operations
and how to access staff after regular business hours.
about UM decisions beyond the confirmation of approved or
denied care are forwarded to UM staff for triage and handling.
During business hours, these inquiries are forwarded to
the Authorization Department and/or case managers. After
regular business hours, members and/or providers are directed
to the case manager, who is on call via the ProMed HCA answering
AND URGENT MEDICAL CARE
is important to understand the difference between a medical
emergency and a non life-threatening situation requiring medical
care. An emergency is any sudden, serious and unexpected acute
illness, injury or condition which would permanently endanger
your health if medical treatment is not received immediately.
Examples of medical emergencies are severe chest pains, convulsions
or seizures, heavy bleeding or unconsciousness. Some conditions
like extreme flu symptoms, or a sprained ankle, may be serious
but do not require emergency care. In case of a life-threatening
illness or injury call 911 or go directly to the nearest emergency
room. If you receive emergency medical care, present your
health plan card to the hospital and request they contact
your PCP. You must contact Pomona Valley Medical Group Inc. within 48
hours of your hospital visit and all follow-up care must be
coordinated by your Pomona Valley Medical Group Inc. PCP. If you seek
medical treatment for non-emergency care outside of the Pomona Valley Medical Group Inc., you may be financially responsible for any
services you receive. For routine urgent care calls, contact
your Pomona Valley Medical Group Inc. doctor during regular office hours.
Calls received outside of regular office hours will be handled
by the on-call physician.
TESTS, TREATMENTS AND HOSPITALIZATION
Pomona Valley Medical Group Inc. PCP will arrange for laboratory,
radiology, and diagnostic services as well as any hospitalization
that may be required. Pomona Valley Medical Group Inc. physicians
are staff members at full-service, acute care hospitals which
provide state-of-the-art medical services. Senior members
can self-refer to PVMG's affiliated hospitals for mammography
screenings only. Please call a ProMed HCA Customer Service
Representative at (909) 932-1045 if you need more information.
minimal co-payment may be required for some professional and
hospital services. Co-payments are usually required at the
time of service by the physician's office, pharmacy, or medical
facility. Please contact a ProMed HCA Customer Service Representative
if you have questions regarding your co-payment requirements.
schedule an appointment with your PCP, consult the Pomona Valley Medical Group Inc. Primary Care Physician Directory or the front
of your health plan membership card and contact your doctor's
office. You should schedule a "get acquainted" visit
with your Pomona Valley Medical Group Inc. PCP within three months and
arrange for a physical examination after your first visit.
Remember to contact your doctor immediately if you can not
make a scheduled appointment.
MANAGED CARE MEMBERS
you have not enrolled with one of the major HMO Medi-Cal plans,
please complete an enrollment form as soon as possible. Your
doctor or a ProMed HCA Customer Service Representative will
assist you if you have questions or if you need help completing
the form. If you belong to a Medi-Cal Managed Care HMO, you
are required to have a doctor's exam within 120 days of choosing
your Pomona Valley Medical Group Inc. PCP. Please contact your PCP to
schedule an appointment when you receive your membership card.
In case of a non life-threatening medical emergency please
contact your PCP. If you are unable to reach your doctor,
a ProMed HCA nurse is on-call 24 hours a day at (909) 932-1045
to assist you.