Frequently Asked Questions


To Top
How does Regal Medical Group interact with my insurance company?
Regal Medical Group represents your physicians. We contract with private practice physicians throughout most of Southern California. Your insurance company ( for example Pacificare, Secure Horizons, AETNA, etc. ) requires you to choose a primary care physician ( PCP ). You’ve chosen a PCP with Regal Medical Group. Your PCP and Regal Medical Group will be coordinating all of your care, using our specialty and hospital network. Your insurance company determines your benefits, for example your co-payment amount when you see a physician or go to an emergency room. If you have your insurance through your employer, your employer and insurance company work together to determine what your monthly premium will be and the premium is paid directly to your insurance company by you or your employer.


To Top
What is the role of my Primary Care Physician ( PCP )?
Your primary care physician ( PCP ) is always the first person you should contact when you have a medical condition. If you think you have the flu, phone your PCP. If you have knee pain, phone your PCP. Your PCP will most likely want to see you before determining if you should be referred to a specialist for a specific condition.
The only exception to this is if you are experiencing a life threatening emergency - for example sudden onset of chest pain. If this should occur, you should always phone 911 or go to the nearest emergency room. We have attached a list of our preferred hospitals and urgent care centers.


To Top
My Primary Care Physician ( PCP ) advises I need to see a specialist. Now what happens?
Your PCP will submit an authorization request to Regal Medical Group. We will then determine which of our specialists is the most appropriate. You will then receive an authorization in the mail.
Routine authorization requests are reviewed and completed within 5 working days. If your PCP advises us that the request is urgent, the review will be completed within 2 working days. Remember – in order for a claim to be paid, you must have an authorization for the service.


To Top
Are there any services that don’t need an authorization?
Regal Medical Group does offer services, called self referral, that do not need an authorization as long as you self refer to a participating specialist. These services are: Well Woman Exams and OB care – first visits.
We also offer several direct referral services. This means that your PCP is able to send you directly to a Regal contracted specialist. You should phone our Customer Service Department at 818-357-5000 for a list of the services available to you.


To Top
Who receives my co-payment?
All co-payments are made to the provider of service at the time services are received. Remember, your insurance company determines your co-payment amount. This is not established by your physician or Regal Medical Group.


To Top
What if I receive a bill?
If you have received an authorization for services or if you have self referred for one of the services indicated on the previous page, you should not receive a bill. There are times when labs or radiology departments may send their patients a bill because they did not get complete information at the time of service. Whenever you receive a bill or statement please phone our Customer Service Department. We do not want you paying something that could have been sent to you due to clerical error.


To Top
We go on vacation a lot. Will I be covered if I should become ill?
We hope that while you are enjoying your vacation you don’t become ill. However should that occur, you should go and see a physician or go to an urgent care location. The majority of the time these visits will be covered, however it’s important for you to know that you may have to pay for the services. Most providers in another area will not bill your insurance company. This is especially true for out of state providers and cruise ships. You need to contact your insurance company and ask for a claim form. Once this is received, mail your receipts to your insurance company for review. This also includes receipts for prescriptions that you may have had filled but remember over the counter medications are not reimbursable.
If you should experience a life threatening emergency while traveling, it is very important that you go to the nearest emergency room. Most emergency rooms will contact your insurance company to advise of your condition, discuss your treatment plan and also determine where bills should be sent.
Upon your return home, be sure to contact your primary care physician (PCP) to advise him/her of your illness while away from home. It’s important that your medical records are updated and if you should need to receive continued care for the condition, your PCP will be the one coordinating any care you receive.


To Top
How do I file a complaint/grievance or an appeal?
We do want to assist each and every member in every way possible. If you have any questions and/or concerns, do not hesitate to contact our Customer Service Department at 1-866-654-3471 anytime between the hours of 08:00 a.m. and 05:00 p.m. Monday through Friday.
Appeals:
If you are not satisfied about a decision regarding the denial of services or payment. Please refer to your Evidence of Coverage (EOC) for detailed instructions on how to file an appeal or you can call your health plan directly.
Grievances:
If you are dissatisfied with Regal Medical Group and/or any of its providers, including quality of care concerns, please contact your health plan and file a formal grievance.
Regal Medical Group strives for excellence in healthcare and will work closely with your health plan to ensure the highest quality of care and strive to meet your satisfaction.
If you have any further questions, you may contact our Customer Service Department at 1-866-654-3471.