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Notice of Language Assistance and Accessibility
Community Care Health Plan offers a no-cost telephonic interpreter service to health plan members, both directly and through Participating Provider offices, to provide language assistance to members with limited English proficiency. To get an interpreter, or to ask about written information in a non-English language, please contact the health plan’s Customer Services department by phone at 1-855-343-2247.
Community Care Health Plan members are all entitled to full and equal access to covered services, including members with disabilities, as required under the Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973.Customer Service representatives for Community Care Health Plan are accessible by phone at 1 – 855 – 343 – 2247, and are available to assist the speech and hearing – impaired.Further, the speech – and hearing – impaired may use the California Relay Service’s toll-free telephone number 1-800-735-2929 or 1-888-877-5378 (TTY).
Timely Access to Care
Health Plans in California must ensure that members 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. Your provider may give you a longer wait time if it would not be harmful to your health. It must be noted in your record that a longer wait time will not be harmful to your health. Members who have questions or believe they need to be seen sooner should contact either their provider’s office or Community Care Health’s Member Services Department at (855) 343-2247.
|Emergency Care (life threatening)||Seek immediate care at the nearest hospital|
|Urgent Care (non-life threatening) – no prior authorization required||Appointment is offered within 48 hours from time of the request|
|Urgent Care (non-life threatening) – prior authorization required||Appointment is offered within 96 hours from time of the request|
|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|
|Non-urgent care appointments with a specialist||Appointment is offered within 15 business days from time of the request|
|Non-urgent appointment with a mental health provider (who is not a physician)||Appointment is offered within 10 business days from time of request|
|Non-urgent appointments for ancillary services for the diagnosis or treatment of an injury, illness or other heath condition||Appointment is offered within 15 business days from time of request|
|Telephone triage and advice*||No greater than 30 minutes|
*Community Care Health also provides access 24-hours-a-day, 7 days per week to talk to a qualified health care professional through Teladoc. Please call (800)-835-2362.
Printed Provider Directory
Printed copies of the Community Care Health Plan provider directory are available at no – cost upon request.To request your printed provider directory please contact the health Plan’s Customer Services department by phone at 1-855-343-2247, by email to email@example.com or in writing at the following address : Community Care Health Plan Customer Service Department, P .O. B ox 45020, Fres no, CA 93718
Provider Directory Inaccuracies
Community Care Health Plan updates the information located in its provider directory at least weekly.If you would like to report a provider directory inaccuracy, you may do so by phone to the health Plan’s Customer Services department at 1-855-343-2247, by email to firstname.lastname@example.org, or by filling out the form available here.
Other Important Information
Members of Community Care Health Plan have their medical care coordinated through their Primary Care Provider who is a Participating Provider in the network maintained by the health plan.Medical services, including those with referrals by your PCP to a Specialist or other healthcare provider, may require prior authorization or a medical necessity determination to be processed as a covered benefit. Emergency services and urgent care services for emergent medical conditions are available without a referral.Review your Evidence of Coverage for detailed information about your benefits and coverage.If you have any questions, or would like help in understanding your benefits, please contact the health Plan’s Customer Services department by phone at 1-855-343-2247.