The Patient Resource Center (PRC)

Our Patient Resource Representatives answer many questions for our patients throughout the day-from "what is managed care?" to "how do I get my prescription refilled?" Below are the top 10 questions and answers that our patients want to know.

1. What is managed care?

Managed care is a system of managing and financing health care delivery to reduce the cost of health care while preserving a high level of care and service. It is a combined clinical and administrative approach to health care delivery. If you choose an HMO insurance plan, you opt for managed care.

In the 1960s, Sunnyvale Medical Clinic was one of the first medical groups in the area to become involved in managed care. Today, Camino Medical Group participates with most major health plans, which has allowed it to continue serving the vast majority of our patients.

2. What is an HMO?

Some insurance plans are Health Maintenance Organizations (HMOs), commonly referred to as a managed health care plan. HMOs were designed to control spiraling health care costs while maintaining quality care and services. This means, for example, you would pay a copayment (small fixed amount) for a doctor visit (with a participating doctor) instead of paying a percentage of the total doctor bill. The doctor / provider is responsible for helping you obtain health care services and providing you with information leading to a healthier lifestyle.

An HMO for Seniors (generally persons over the age of 65) is called a Medicare Risk HMO which replaces a patient's Medicare benefits. These insurance plans have no membership fees. Benefits vary amongst the health plans. Camino Medical Group accepts Secure Horizons and HealthNet Seniority Plus.

3. What types of health care payments are there?

A premium is the monthly or annual amount paid by the patient, or patient/employer, or employer to the insurance plan (payor) for the insurance coverage.

A copayment is a small fixed payment determined by the insurance company that is paid by the patient to the provider at the time of services rendered.

A deductible is typically a fixed annual amount associated with indemnity plans that is paid by the patient for services rendered before the insurance plan will pay for any expenses. e.g. Many dental plans have deductibles such as 80/20 which means the insurance will cover 80% of the charge and the patient is responsible for 20% of the charge.

4. What is a provider?

A provider is a medical group, IPA, hospital, health care facility or health care professional that provides health care services to patients. This may be a single hospital, an individual such as a physician, nurse practitioner or physician assistant, or a group or organization. When you sign up for an HMO insurance plan, you are asked to select a provider from the insurance plan's provider directory. Camino Medical Group physicians can be found under the heading "Camino Medical Group." You can choose the group before choosing a primary care physician if you want to get acquainted with your physician first.

In an HMO, most primary and specialty care is provided within the provider group. Generally, this means if you see a physician outside the medical group, your insurance plan will not pay for the visit. That is why it is important to have a primary care physician to assist you in obtaining specialty care.

5. What is a primary care physician?

A primary care physician (PCP) is a pediatrician, family or general practice physician or internist who oversees ALL your health care, from routine physical examinations to specialist and urgent/emergent care. This allows your PCP to develop an understanding about you that is difficult for intermittent physicians to match. The close relationship you establish with him/her will enhance accurate diagnoses, preventive medicine and education.

If you belong to an HMO, you must choose a provider within a medical group or IPA. Our Patient Resource Center can assist you with getting established with a physician. Your primary care physician is part of a large network of physicians at CMG who will refer you to the specialist when necessary.

6. What if I need to see a specialist?

Camino Medical Group has 28 subspecialties including Cardiology, Orthopedic Surgery and General Surgery. There are times that direct access to a specialist is appropriate and the most expedient. Camino Medical Group does provide direct access to many of our specialties, however, scheduling preference is provided to patients with a primary care referral. Your primary care physician can help to determine the emergent nature of the specialist visit and can help expedite your appointment.

7. What do I need to do if I'm a new patient of Camino Medical Group?

Once you have selected Camino Medical Group as your provider, you should select a primary care physician. For assistance in choosing a PCP, call the Patient Resource Office at 650-934-7080.

If you have never been seen at Camino Medical Group, you will need to establish a medical chart number. This unique number helps us to organize all your information under one chart, which means less paperwork for you to fill out! Your chart number will be issued at the time of your first appointment. Please plan on arriving to the doctor's office at least 10 minutes early to establish your chart.

If you were seen at one of our Urgent Care Centers for your first visit, a chart was created for you at that time. If you already have a chart number you will not need to arrive early for your first appointment.

8. How do I make an appointment?

Once you have selected a primary care physician, call his/her office directly to schedule an appointment. Some physician practices are nearly full so you should call several weeks ahead for a first appointment for new patients or for a "comprehensive physical examination" for established patients.

9. What if I need to be seen today for an illness?

For medical emergencies and illnesses that are not life threatening, but may require a same day appointment, call your primary care physician's office. Your doctor will determine if you should be seen more immediately at the urgent care center or if you may need to go to an emergency room at the hospital. As always, if this is a life threatening emergency, call 911 or go to the hospital immediately.

10. How do I order a prescription refill?

Preferably, you should call your pharmacist to request a refill at least 24 - 48 hours ahead of time. Your pharmacist will contact your doctor directly. If your doctor is out-of-town, the physician on-call will coordinate the refill with your pharmacist. Please note that if you need a refill for a classified narcotic, you must pick up the prescription at the doctor's office. These prescriptions can not be filled by phone.