Encompass Medical Group offers all major PPO and HMO plans in addition to Medicare and Tricare.
As a contracted Managed Care Organization, Encompass Medical Group is delegated by its contracted HMO health plans to render medical management decisions. Based on the recommendation of your Encompass physician, decisions regarding your medical care are made, based on the appropriateness of care and the existence of coverage set by your health plan. Decisions by Encompass Medical Group to either approve or deny a requested service are based upon Utilization Management (UM) review criteria, based on reasonable medical evidence and acceptable medical standards of practice, used in conjunction with the application of professional medical judgment and consideration of the needs of the individual patient and characteristics of the local delivery system. As a decision-maker, Encompass Medical Group and its Physicians do not accept any monetary reward for non-approval of services and their compensation to provide utilization review services, does not contain incentives, direct or indirect, to make its review decisions.
EMG will make UM criteria available upon request to Patients, Providers or the public at large. Written or verbal requests should be directed to the UM/QA Coordinator by calling 619-660-6212, or by calling collect to 619-660-5719.
We do not offer MediCal. Please contact MediCal web site for directory information to the closest MediCal provider.
