California law requires health plans to provide health care appointments and telephone advice in appropriate time frames.

Appointment Wait Times

Beginning January 17, 2011 health plan members have the right to appointments within the following time frames:

• Within 48 hours of a request for an urgent care appointment for services that do not require prior authorization,
• Within 96 hours of a request for an urgent appointment for services that do require prior authorization,
• Within ten (10) business days of a request for non-urgent primary care appointments,
• Within fifteen (15) business days of a request for an appointment with a specialist,
• Within ten (10) business days of a request for an appointment with non-physician mental health care providers, and
• Within fifteen (15) business days of a request for a non-urgent appointment for ancillary services for the diagnosis or treatment of injury, illness, or other health condition.

Telephone Wait Times

Beginning January 17, 2011 health plan members have the right to the following telephone services within the following time frames:

• Triage or screening services by a qualified health professional to decide the urgency of a health condition: 24 hours a day, 7 days a week. If a call-back to the member is required, it must be within 30 minutes.
• Speak to a plan’s customer service representative within 10 minutes during normal business hours.

While the law sets these time frames, health care providers can be flexible in scheduling appointments if a longer time frame is appropriate for the member’s health. It must be noted in the member’s record that a longer waiting time will not be harmful to the health of the member.

In geographic areas with provider shortages, if timely appointments are not available, a health plan must refer members to, or, in the case of a preferred provider network, assist members in locating appropriate contracted providers in neighboring service areas.

Read more about what plans must do and other background information on the timely access law.