Member Information

How To Access Care

Prospect’s provider network is a combination of primary care and specialty physicians, urgent care centers, hospitals and other healthcare providers that work together to help provide you quality medical services.

Primary Care Physician (PCP)

Your PCP is the main doctor you will see for check-ups and routine care to keep you healthy. Your PCP works with you and Prospect as part of your team to help coordinate your healthcare services, which may include specialist referrals, lab tests, outpatient referrals or services, medical supply requests, and/or any other healthcare services necessary for your care.

If an authorization is needed for a referral or request, it will be sent by your PCP to Prospect’s Utilization Management Department for approval. Most referrals or requests are received back within five business days and many can be approved the same day. If you have a question about a referral or the status of an authorization request, you can contact your PCP office, or call Prospect’s Customer Service Team at 800-708-3230.

If at any time you would like to choose a new PCP or would like guidance selecting a PCP, you can do so by calling our Customer Service Team at 800-708-3230 Monday through Friday, 8:00 a.m. through 5:00 p.m. Pacific Time.

You can also search for providers by using our Find a Doctor search tool.

MAKE AN APPOINTMENT WITH YOUR PCP

Once you have chosen your PCP, you should call to make an appointment. This first visit will help you get to know your doctor and your doctor get to know you.

MAKE TIME TO READ YOUR MEMBER HANDBOOK

Your health plan will send you a Member Handbook. This is a helpful guide and will give you more tips on how to access your healthcare.

HOSPITAL SERVICES

If you require a stay in the hospital, you may be assigned a hospitalist. This is a physician who will work with your PCP from admission to discharge to ensure your care is coordinated with physicians and specialists to provide you with the best care possible.

NEED TO SEE A SPECIALIST?

Call your PCP and make an appointment. If your PCP agrees that you need to see a specialist, a referral will be created and sent to Prospect for review.

Urgent Care

If you are experiencing an emergency or life-threatening condition, please call 9-1-1 or go to the nearest emergency room.

Generally, urgent care centers provide a more rapid means of treating less severe medical conditions, as opposed to emergency rooms, and often at a lower co-payment (depending upon your health plan’s benefits). They are usually open after normal business hours, including evenings and weekends.

Prospect provides urgent care services for non-life-threatening emergencies that occur outside of normal doctor office hours. Urgent medical conditions are ones that are not considered emergencies, but still require care within 24 hours. Some examples include:

  • Sore throat or ear aches
  • Fever
  • Minor injuries, burns or lacerations
  • Skin infections and rashes
  • Minor fractures or broken bones
  • Backaches
  • Frequent urination or burning sensation when urinating
  • Persistent vomiting
  • Abdominal pain or cramping
  • Allergic reactions
  • Insect or animal bites
  • Sports injuries
  • Sinus problems or other upper respiratory infections

You can see a list of our Urgent Care Centers here.

IN AN EMERGENCY

In case of emergency, call 9-1-1 or go to the nearest hospital emergency room. An emergency is a medical condition with severe symptoms that require immediate medical attention that otherwise may place a person’s health in serious danger or cause serious impairment to the bodily function or organs of that person. Some examples of an emergency are, but not limited to:

  • Severe chest pain or difficulty breathing
  • Compound fracture (bone protrudes through skin)
  • Convulsions, seizures or loss of consciousness
  • Fever in newborn (less than 3 months old)
  • Heavy, uncontrollable bleeding
  • Deep knife wounds or gunshot wounds
  • Moderate to severe burns
  • Poisoning
  • Serious head, neck or back injury
  • Pregnancy-related problems
  • Severe abdominal pain
  • (Signs of) heart attack (i.e., chest pain lasting longer than two minutes)
  • (Signs of) stroke (e.g., loss of vision, sudden numbness, weakness, slurred speech, or confusion)
  • Suicidal or homicidal feelings.

PRESCRIPTION MEDICATIONS

For questions about filling prescribed medicines, please contact your health plan.

ADDITIONAL QUESTIONS

Our Customer Service Team is here to answer any questions you have and to listen to your concerns. We care about you and your health. We are available Monday through Firday, 8 a.m. to 5 p.m., Pacific Time, at 800-708-3230. You can also email our Customer Service Team at memberservices@prospectmedical.com.