SUN HEALTH MEDICAL CLINIC
, Inc.
Regardless of the weather, let's navigate together.
REFERRAL
REFERRAL
Health Maintenance Organization
(HMO)
Health Maintenance Organization
(HMO)
Preferred Provider Organization
(PPO)
Preferred Provider Organization
(PPO)
HMO | PRIMARY CARE PROVIDER
If you have an HMO plan, you need to go to your Primary Care Provider (PCP) first. The PCP will treat you based upon a medical algorithm. If you symptoms are not resolving, you will need a higher level of testing, treatment, and/or referral.
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HMO | INDEPENDENT PRACTICE ASSOCIATION
All referrals with an HMO / managed care need to be authorized by an Independent Practice Association (IPA), which is an intermediary between the patient, health plan, and providers. Our associated IPA is Mercy Physicians Medical Group (MPMG), located in San Diego.
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HMO | IN NETWORK SPECIALISTS/PROVIDERS
These are all local to the San Diego area. For this reason, HMO health plans suggest you live within 15 miles of your PCP.
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HMO | TIMELINE
It may take 0-5 business days to receive authorization. Upon authorization, if the specialist does not contact you within 24 hours or if it is urgent, you call the specialist. Please inform them that the referral is from Mercy Physicians Medical Group (MPMG). If you are not able to be scheduled within 15 business days for a non-urgent issue (or 96 hours for an urgent issue), please inform us and/or call MPMG at 1.800.515.8889 x3.
PPO | PCP NOT REQUIRED
If you have a PPO plan, you do not need a referral from a PCP, however many specialists prefer referral from and coordination with a PCP.
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PPO | REFERRALS
Your PCP can direct you to a specialist and you may verify they are in network on your health insurance website. You can choose a nationwide contracted specialist.