Central California Alliance for Health | Living Healthy | March 2021

We know it is important for you to get care when you need it. But it is not always possible for a doctor to see you right away. You may have to wait longer for some types of appointments than others. For example, you should be able to get an urgent care (care when you are sick) appointment sooner than an appointment for a regular checkup. We work with the doctors and clinics in our network to make sure you can get care when you need it. We have always done this because we know it is important. Health plans in California have to meet certain standards for access to care. The regulations to put this law into place are called the Timely Access to Non-emergency Health Care Services standards. There are different standards for different types of appointments. In the chart at right are the standards for different types of appointments. The waiting times for an appointment may be longer if the provider feels that it will not harm your health. Appointment type Must get appointment within Urgent care appointments that do not require pre-approval (prior authorization) 48 hours Urgent care appointments that do require pre‑approval (prior authorization) 96 hours Non-urgent primary care appointments 10 business days Non-urgent specialist appointments 15 business days Non-urgent appointment with a mental health provider (non-doctor) 10 business days Non-urgent appointment for ancillary services for the diagnosis or treatment of injury, illness or other health condition 15 business days Telephone wait times during normal business hours 10 minutes Triage 24/7 services—no more than 30 minutes GETTING AN APPOINTMENT How long should you have to wait? IF YOU FEEL that you are not getting care when you need it, call Member Ser vices at 800-700-3874 (TTY: Dial 7‑1‑1 ). 3 HEALTHY