California timely access to care
Covered health care services are provided and arranged in a timely manner, as appropriate for the nature of condition, as consistent with good professional practice and meet the California standards regarding access to care.
Appointment wait times are as follows:
- Emergency health services are available and accessible within the plan’s service area 24 hours, 7 days a week. Ambulance services for the service area served by the plan for transportation to the nearest 24-hour facility with physician coverage.
- Urgent health care services that do not require prior authorization are offered within 48 hours of the request. Urgent health care services that require prior authorization are offered within 96 hours of the request.
- Non-urgent care primary care and non-urgent, non-physician mental health services are offered within 10 business days of the request.
- Non-urgent specialist care and ancillary services (i.e. vision care services) are offered within 15 business days of the request.
Providers in our network are required to have appointment availability within specified time frames:
- Emergency services: 24 hours
- Urgent appointments: within 72 hours of the time of request for appointment
- Non-urgent and preventive dental care appointments: within 14 business days
Telephone triage/Nurse lines
Telephone triage or screening services are provided in a timely manner appropriate for the insured's condition. During normal business hours, the waiting time for a plan member to speak by telephone with a customer service representative knowledgeable and competent regarding the plan member’s questions and concerns will not exceed ten minutes.
Interpreter services will be coordinated with scheduled appointments for covered health services in a manner that ensures interpreter services will be available at the time of the appointment.