Timely Access To Care
Health Plans in California must ensure that you have timely access to their physicians and other providers when seeking care. This means that there are limits on how long you have to wait to get an appointment and telephone advice. The wait times are shown in the chart below. Some exceptions to the wait times apply. Sometimes waiting longer for care is not a problem. A provider may give a you a longer wait time if they determine it would not be harmful to your health. In this event, the provider will note in your record that a longer wait time will not be harmful to your health. If you have questions, please call Community Care Health’s Member Services Department at (855) 343-2247.
| Access Type | Standard |
|---|---|
| Access to non-urgent appointments with a Primary Care Physician (PCP) for regular and routine primary care services | Appointment is offered within 10 business days from time of the request |
| Access to Urgent Care services with a PCP that does not require prior authorization – includes appointment with a physician, nurse practitioner or physician’s assistant in officer | Appointment is offered within 48 hours from time of the request |
| Access to after-hours care with a PCP | Ability for Member to contact an on-call physician after hours; return call within 30 minutes PCP provides appropriate after-hours emergency instructions |
| Access to non-Urgent Care appointments with a Specialist | Appointment is offered within 15 business days from time of the request |
| Access to Urgent Care services that require prior authorization with a Specialist or other provider | Appointment is offered within 96 hours from time of the request |
| Telephone triage and screening | Provided within 30 minutes |
| Non-urgent appointments for ancillary services for the diagnosis or treatment of an injury, illness or other health condition | Appointment is offered within 15 business days from time of request |
| Non-urgent appointments with a mental health or substance use disorder provider (who is not a physician) | Appointment is offered within 10 business days from time of request |
| Non-urgent follow-up appointments with a non-physician mental health or substance use disorder provider for members undergoing a course of treatment for an ongoing mental health or substance use disorder condition | Appointment is offered within 10 business days of the prior appointment |
Other Regulatory Requirements:
After Hours Care: You should be able to reach a recorded message or live voice response providing emergency instructions and for non-emergent (urgent) matters information when to expect to receive a call back.
Emergency Care: Providers should instruct their after-hours answering service staff that if the caller is experiencing an emergency, the caller should be instructed to dial 911 or to go directly to the nearest emergency room. Answering machine instructions must also direct the member to call 911 or go the nearest emergency room if the caller is experiencing an emergency.