Timely Access to Care

www.HealthHelp.ca.gov - If you are having health problems, it is important for you to get the care you need when you need it.

In California, your health plan must give you the care you need within a certain amount of time.

So, how long should you have to wait to receive the medical services you need?

If you believe you are experiencing a medical emergency, dial 9-1-1 or go to the nearest hospital.

If your health issue is urgent, but not an emergency, and does not require prior approval or authorization from your health plan, you have the right to get care within two days.

If the care needs approval or authorization by your health plan, you have the right to get care within four days.

If your health concern is not urgent and can be covered by your primary care physician, you must receive care within 10 business days, or two weeks.

Non-urgent appointments with a specialist or appointments to diagnose or treat a condition which include lab tests, MRIs or x-rays, should be scheduled within 15 business days, or three weeks.

Your health plan should offer telephone services 24 hours a day, 7 days a week and let you speak with a qualified health professional, who can help you decide if your condition is urgent. You can find the phone number on your health plan membership card.

You might need an appointment faster than the law requires. If this happens, contact your health plan at the toll-free number provided on your membership card.

When waiting longer for care is not a problem, your provider may not schedule you an appointment within the timely access standard timeframe. If this happens, your provider must note it in the relevant record saying the extra time will not affect your health.

Also, if you are offered an appointment within these standards, but chose an appointment with a longer wait time, your health plan has still met the requirement.

Sometimes, there might not be enough providers near you. If this happens, your plan must help you get an appointment.

If you are having problems getting appointments on time, first contact your health plan at the toll-free number provided on your member card.

If you still have trouble getting a timely appointment, then the Department of Managed Health Care Help Center can assist you.

Contact the DMHC Help Center at 1-888-466-2219 or visit www.HealthHelp.ca.gov.