Timely Access to Care

California law requires health plans to provide timely access to care. This means that there are limits on how long you have to wait to get health care appointments and telephone advice.

If you have a problem getting timely access to care, you should call your health plan. If your plan does not resolve your problem, contact the Help Center.

Timely Access to Care Fact Sheet (Sus derechos al obtener atención médica (Hoja informativa))

Wait Times from Date of Request for Appointment

Health plan members have the right to appointments within the following time frames:

Timely Access to Care: Urgent Care - 2 days for prior authorization not required by health plan; 4 days for prior authorization required by health plan. 
Non-Urgent Care: Doctor Appointment: Primary Care Physician - 10 business days; Specialty Care Physician - 15 business days; Mental Health Appointment (non-physician) - 10 business days; Appointment (aricillary provider) - 15 business days

1 Examples of non-physician mental health providers include counseling professionals, substance abuse professionals and qualified autism service providers.

2 Examples of non-urgent appointment for ancillary services include lab work or diagnostic testing, such as mammogram or MRI, and treatment of an illness or injury such as physical therapy.

Telephone Wait Times

  • You can call 24-hours-a-day, 7 days a week to talk to a qualified health professional to decide if your health problem is urgent. If someone needs to call you back, they must call you within 30 minutes. Look for the phone number on your health plan membership card.
  • If you call your plan’s customer service phone number, someone should answer the phone within 10 minutes during normal business hours.

Exceptions

  • The purpose of the timely access law is to make sure you get the care you need. Sometimes you need appointments even sooner than the law requires. In this case, your doctor can request that the appointment be sooner.
  • 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.
  • If you cannot get a timely appointment in your area because there are not enough providers, your health plan must help you get an appointment with an appropriate provider.

 Timely Access Regulation