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 Fact Sheet
Appointment Wait Times
Health plan members have the right to appointments within the following time frames:
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Urgent Appointments
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Wait Time
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for services that don’t need prior approval
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48 hours
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for services that do need prior approval
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96 hours
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Non-Urgent Appointments
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Wait Time
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Primary care appointment
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10 business days
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Specialist appointment
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15 business days
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Appointment with a mental health care provider (who is not a physician)
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10 business days
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Appointment for other services to diagnose or treat a health condition
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15 business days
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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 can’t 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