Timely Access To Care

Health Plans in California must ensure that you 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. A provider may give a you a longer wait time if they determine it would not be harmful to your health. In this event, the provider will note in your record that a longer wait time will not be harmful to your health. If you have questions, please call Community Care Health’s Member Services Department at (855) 343-2247.

Appointment TypeStandard
Emergency Care (life threatening)Seek immediate care at the nearest hospital
Urgent Care (non-life threatening) – no prior authorization requiredAppointment is offered within 48 hours from time of the request
Urgent Care (non-life threatening) – prior authorization requiredAppointment 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 servicesAppointment is offered within 10 business days from time of the request
Non-urgent care appointments with a specialistAppointment 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 conditionAppointment is offered within 15 business days from time of request
Telephone triage and adviceNo greater than 30 minutes
Behavioral Health Emergent & Non-Emergent Appointment Access Standards
Appointment TypeStandard
Non-urgent appointments with a physician mental health care providerMust offer the appointment within 10 business days of request
Non-Urgent Care appointments with a non-physician mental health care providerMust offer the appointment within 10 business days of request
Urgent Care appointmentsMust offer the appointment within 48 hours of request
Access to Care for Non-Life Threatening EmergencyWithin 6 hours
Access to Life-Threatening Emergency CareImmediately
Access to Follow Up Care After Hospitalization for mental illness Must Provide Both:
  • One follow-up encounter with a mental health provider within 7 calendar days after discharge
  • Plus
  • One follow-up encounter with a mental health provider within 30 calendar days after discharge

Other Regulatory Requirements:

After Hours Care: You should be able to reach a recorded message or live voice response providing emergency instructions and for non-emergent (urgent) matters information when to expect to receive a call back.

Emergency Care: Providers should instruct their after-hours answering service staff that if the caller is experiencing an emergency, the caller should be instructed to dial 911 or to go directly to the nearest emergency room. Answering machine instructions must also direct the member to call 911 or go the nearest emergency room if the caller is experiencing an emergency.