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FAQ

Key Medical Group is an Independent Physician Association (IPA) of primary care doctors and specialists who work together to provide excellent healthcare to our members.  Key Medical Group manages Blue Shield of California, Anthem Blue Cross, Health Net, Humana (Medicare Advantage), and UnitedHealthCare.  For more information about the health plans please refer to our Health Plan Contacts page.

  • Referrals

    Referrals to specialists must be coordinated by your Primary Care Physician (PCP), who is responsible for the overall management of your healthcare. Most referrals are confirmed by a referral authorization letter which includes the specialist name, number of visits and expiration date of the referral. Your Primary Care Physician should make arrangements for your appointments.  Prior authorization will need to be obtained prior to making any appointments for most services.

    Checking Referral Status

    Call Key Medical at (559) 735-3892.  We are available Monday through Friday from 8:00 AM-5:00 PM. You may also check with your doctor's office.

    Laboratory Services

    Laboratory services are capitated. Members assigned to Visalia or Exeter primary care providers are required to use Kaweah Health.  Members assigned to Tulare, Dinuba, Hanford, Corcoran, and Lemoore primary care providers are required to use Quest Diagnostics. Members assigned to Porterville and Lindsay are required to use Sierra View Medical Center. For locations of draw sites, please click here.

    Emergency Room Access

    Perhaps the most commonly denied service is medical care obtained through the emergency room or urgent care center. Often this results in angry responses from those denied coverage, as these services can be quite expensive. You can save yourself both time and money by following some general guidelines.

    Contact your primary care provider regarding your condition before going to the E.R. or Urgent Care Center. Often symptoms you consider emergent can be handled over the phone. Sometimes antibiotics can be prescribed for urinary tract, sinus, or ear infections. High fevers in children are rarely emergent and can be managed with combinations of Tylenol, Ibuprofen and a cool washcloth. Pain management; whether low back, headache, abdominal, or limb; can also be evaluated and treated over the phone depending on its severity. Vomiting and diarrhea can often be relieved by over-the-counter and prescription medications. It is important to call your doctor before going to the emergency room or urgent care center so he/she can best advise you on what to do.

    Certainly some conditions are so emergent that you do not have time to contact your physician. Sudden onset of severe chest pain, shortness of breath, loss of consciousness, weakness on one side of the body, new seizures and persistent fast irregular heartbeats are all indications of potentially serious conditions. Injuries resulting in an obvious fracture or open wound also require immediate care. In these cases, contact your physician the following day so they can request authorization for the E.R. or urgent care.

    Hopefully you will never need urgent/ emergent care. If you do, however, following these guidelines may save you time and expense in the future. If you and others follow these guidelines this may insure that the emergency room physician will be able to see you in a timely manor and reduce unnecessary time to see non-emergent conditions.

    Direct Access for Women

    Under the HMO’s, women have direct access to contracted OB/GYN’s within the Key Medical Group panel.  Direct access means the member can see the OB/GYN without a referral for evaluation and management services.  

    For a list of Key Medical Group contracted OB/GYN providers please go to our Physician Roster page and download the specialist file.

  • LOCATIONS

    Hours subject to change. Please contact location to confirm. 

    Porterville

    • Sequoia Family Medical Center
      590 W Putnam,
      Porterville, CA
      (559) 781-3700
      Mon-Fri, 8:00am - 8:00pm
      Sat, 9:00am - 6:00pm
      Sun, 9:00am - 3:00pm

    Visalia

    • Kaweah Delta Urgent Care
      3600 W Flagstaff Ave
      Visalia, CA
      (559) 624-6800
      Daily, 8:00 am-8:00 pm

    • Kaweah Delta Urgent Care
      1633 S. Court
      Visalia, CA
      (559) 624-6090
      Daily, 8:00 am-8:00 pm

    • Sequoia Prompt Care
      1110 S. Ben Maddox Way
      Visalia, CA
      559-642-4800
      Mon - Fri 9:00 a.m - 8:00 p.m.
      Weekends 10:00 a.m. - 5:00 p.m.
      sequoiapromptcare.com

    • QuickCare
      5400 W Hillsdale Ave
      Visalia, CA
      (559) 738-7555
      Mon – Fri 8:00 a.m. – 8:00 p.m.
      Saturday 8:00 a.m. – 5:00 p.m.
      Sunday 9:00 a.m. – 2:00 p.m.

    • Premier Walk In Medical Caldwell
      4025 W Caldwell Ave Ste A
      Visalia, CA
      (559) 733-4505
      Mon - Fri 8:00 a.m. - 6:00 p.m.
      Weekends 9:00 a.m. - 2:00 p.m.

    Hanford

    • Adventist Health Physician Network
      Same-Day Appointment Center
      1524 W Lacey Blvd #101
      Hanford, CA
      (559) 537-0305
      Mon-Fri, 7:00 am-7:00 pm
      Weekends & Holidays, 8:00 am-12:00 pm

    For a complete list of Urgent Care location please print our Urgent Care Resource Page.


    What is Urgent Care?

    Urgent Care does not replace your primary care physician (PCP), who is responsible for all of your medical care, but is available to provide non-emergency urgent care services when your primary care physician is not able to see you.  Urgent Care is available with extended hours into the evenings and weekends.  No appointment or referral is necessary.


    Does urgent care replace emergency room visits?

    Urgent care is not intended to replace emergency room visits for serious, life threatening emergencies.  It should be used as a sensible alternative to the emergency room for minor illnesses and injuries.


    Will my insurance cover urgent care?

    Key Medical Group has contracted with several urgent care facilities and the care you receive at those contracted urgent care offices are covered.  Please refer to the Urgent Care Resource Page for our list of contracted urgent care facilities.  


    How long will I have to wait?

    Wait times vary but are usually faster than the wait times in the emergency rooms.  The urgent care staff will treat you as quickly as possible and some allow you to call in ahead of time and make a same day appointment.

    What to do before going to the emergency room or urgent care:

    • Call your Primary Care Physician (PCP) first unless you feel that you cannot safely wait.

    • In major emergencies, call 9-1-1 for an ambulance or proceed directly to the nearest emergency room.

    What to do after visiting the emergency room or urgent care:

    • Call your Primary Care Physician (PCP) as soon as possible.

  • Laboratory services must be provided by your designated laboratory provider.  Your primary care provider's (PCP) location determines which laboratory facility you must use under your health plan.  Members assigned to Visalia and Exeter PCPs must go to Kaweah Delta District Hospital, members assigned to Tulare PCPs must go to Quest Diagnostics, and members assigned to Hanford, Corcoran, Dinuba, and Lemoore PCPs must go to Quest Diagnostics.  Members assigned to Porterville and Lindsay PCPs must use Sierra View District Hospital.  If laboratory services are performed other than the designated facility, the member could be held financially responsible for the payment.  Listed below are the following draw sites available to you.

    • Kaweah Delta Hospital - Basement
      400 W. Mineral King Ave.
      Visalia, CA 93291
      Phone: (559) 624-2251
      Hours: Mon-Fri, 7:00 am-6:00 pm
      Sat, 7:30 am-4:00 pm
      **Please stop at the first floor information desk to register before continuing to the laboratory

    • Quest Diagnostics - (Members assigned to PCPs in Corcoran, Dinuba, Hanford, Lemoore)
      1120 N Irwin St
      Hanford, CA 932530
      Phone: (559) 582-0308
      Hours: Mon-Fri, 7:00 am-4:00 pm

      1122 Rose Ave, Ste 2
      Selma, CA 93662
      Phone #: (559) 891-1358
      Hours: Mon-Fri, 7:00am-4:00pm

    • Sierra View District Hospital - (Members assigned to PCPs in Lindsay & Porterville)
      263 N Pearson Dr. (north of Emergency Dept.)
      Porterville, CA 93257
      Phone: (559) 781-7877
      Hours: Mon-Fri, 6:30 am-5:15 pm

    For a complete list of available draw sites please download our Laboratory Services Draw Site Directory.

  • Key Medical Group is part of the integrated Delivery Network known as Sequoia Integrated Health along with Kaweah Delta Health Care District and Humana. Partners, caring for you.

    Key will manage your Humana Medicare Advantage Plan. That means we are the local Tulare and Kings County folks to help coordinate your care. We are here to assist you.


    Our Clinical Department Staff also known as “The Virtual Care Team” (VCT) consists of:

    • (1) Medical Director

    • (9) Registered Nurses Case Managers

    • (2) Licensed Vocational Nurses 

    • (2) Social Workers

    • (4) Health Coaches

    • (2) Inpatient Case Managers

    • (2) Department Assistants

    KDHCD Team Members:

    • (2) Clinical Pharmacists

    • (1) Pharmacy Tech

    What can the VCT staff assist with?

    • Care Coordination

    • Referrals / Authorizations

    • Medical needs

    • Pharmaceutical needs

    • Social needs

    The Key Medical Virtual Care Team contact number:              
    (559) 802-1991

    Humana Contact Numbers:
    Humana Local Fresno Office
    (559) 221-2522


    Code: KEY

    Humana is a Medicare Advantage Plan. If you aren’t already a Humana Key Medical Group member and want more information please call: (559) 802-1991.


    Forms and Brochures

  • All appeals for denied services are handled directly through your health plan (Blue Shield, Anthem Blue Cross, etc…). A provider or patient may file an appeal.  An expedited appeal would be requested if it is determined that a delay in the decision making process might pose an imminent and serious threat to the patient's health.  If it were determined by the health plan that an appeal meets this criteria, an expedited review would apply to the case.  An appeal may be filed either by telephone, writing and with some health plans, online.  Once an appeal is in process, your health plan will notify Key Medical Group and will request a copy of your denial letter and any notes we've received from your physician. 

    Every health plan follows different guidelines and procedures.  For more information please refer to the health plan's Appeals & Grievance process available through their website.

    In addition to the process described above, you may also contact the California Department of Managed Health Care (DMHC). The DMHC is responsible for regulating health care plans.  The department has a toll free number (800-400-0815) to receive complaints regarding health care plans.  If you have a grievance against the health plan, you should first telephone the plan and use the grievance process before contacting DMHC.  If you need help with a grievance which had not been satisfactorily resolved, or has remained unresolved for more than 30 days, you may call the DMHC for assistance.

    IF YOU HAVE ANY QUESTIONS REGARDING THE AUTHORIZATIONS PROCESS, PLEASE FEEL FREE TO CONTACT THE KEY MEDICAL GROUP AT (559) 734-1321, 8 AM TO 5 PM MONDAY THROUGH FRIDAY. 

  • What is an ACO?

    Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.

    The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

    When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will create shared savings for the health system, health plans and patients.

    ACO Name and Location


    Participating Providers:

    • Kaweah Delta Health Care District

    • Tulare Family Practice Medical Group

    • Visalia Family Practice Medical Group

    • Sierra View Nephrology Inc

    • Laura T Russo Herrera, MD

    • Adolph J Nava, MD Inc

    • Maria Emilia Cunanan, MD

    • Francis Cunanan, MD

    • Vinay K Buttan MD Inc

  • More information here.

  • Your privacy is very important to Key Medical Group. If you would like for Key Medical Group to speak to someone on your behalf you will need to complete the Information Release Form below and mail it to our office at Key Medical Group 3335 South Fairway, Visalia, Ca. 93277.

    Key Medical Group Forms