Key Medical Group is an Independent Physician Association (IPA) covering Tulare and Kings Counties. Key Medical Group is contracted with your primary care physician and your health plan to manage your medical needs. You have selected an HMO health plan. This means all medical services you may need must be coordinated between your primary care physician and Key Medical Group. Services requiring authorizations and payment of services received are all coordinated by Key Medical Group.
When your physician requests services that require prior authorization, the request is sent to Key Medical Group for review by a physician reviewer. Some of the services that require prior authorization include MRI’s, CT’s, diagnostic tests and any service outside of the Key Medical Group contracted provider panel. These services must be medically necessary and medical criteria must be met prior to the services being received. When you need to be referred to a specialist your primary care provider will select from the Key Medical Group contracted provider list. The referral to the contracted provider in most cases is automatically approved by Key Medical Group. Your primary care physician will simply notify Key Medical Group that they are referring you via Cerecons our on-line physician portal. You will be notified by mail when services are approved or in cases where services are not approved. Sometimes a requested service may be denied, but another service may be approved in its’ place. Please read authorization letters you receive carefully.
All determinations are based on appropriateness of care and service. Authorization request forms, physician progress notes, lab reports, x-ray reports are all reviewed to establish medical necessity and appropriateness of requested treatment. All requests are reviewed with consideration to patient age, comorbidities, home environment, progression of treatment to date, psychosocial needs, availability of service and benefit guidelines. Patients and Physicians are encouraged to discuss appropriate alternative treatments, including the risks and benefits of such treatment as well as the member’s right to refuse treatment. Physicians are not restricted in advocating for or advising members on treatment options. Key Medical Group does not financially reward or encourage decisions based on fiscal concerns.
You must use Key Medical Group contracted providers unless the service is an emergency or if the service is not available within our provider panel. If the service is not an emergency but you need to be seen outside of our provider panel, your local physician must request authorization before the service is provided.
Our office hours are 8 A.M. to 5 P.M. Monday through Friday. If you have questions regarding an authorization request or a claim, please contact us during those hours. Our phone number is (559) 734-1321 or for the hearing impaired 711. If you need language assistance to understand any letters you receive from us, we can obtain the services of an interpreter to translate them for you.
Key Medical Group does not give medical advice, if you have a medical question, please contact your primary care physician. If you have an emergency situation where life or limbs are threatened, call 911 or go to the nearest emergency room. For non-emergency situations, please contact your primary care physician who may either arrange to see you that day, or direct you to a contracted urgent care center to be seen.
All services you receive must be performed by a Key Medical Group provider or you could be held financially responsible. Together you and your primary care physician can select from Key Medical Group contracted providers when medical services are needed. Please make sure that any providers you see are part of the Key Medical Group panel and make sure when you require laboratory or radiology services that they are provided through a contracted provider. Radiology services can be rendered by any contracted provider however laboratory services must be provided by your designated laboratory provider. The primary care providers location determines the laboratory provider. For example primary care providers in Visalia and Exeter are required to send their patients to Kaweah Delta Health Care District laboratories. Tulare primary care providers are required to use Tulare Regional Medical Center and primary care providers in Hanford, Corcoran, Dinuba, and Lemoore are required to use Quest Diagnostics and members who have Porterville primary care providers are required to use Sierra View Medical Center . If laboratory services are not provided by the designated laboratory you could be financially responsible for the payment. If someone directs you to a laboratory other than your designated laboratory please call Key Medical Group first to make sure the service will be covered.
Key Medical Groups team is here to assist you and to make sure you receive the best medical care possible. Please call our office at (559) 734-1321 or toll free at (800) 539-4584 if you have questions.