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Access to Care
Several California laws are in place to help ensure that you can access the care you need.
Timely Access to Care
California law protects your ability to get timely care through your health plan. Health plans must have enough in-network providers in an area in order to provide timely care.
Most health plans are required to meet the following time-based standards:
- You can expect to see a primary care doctor within 10 business days and a specialist within 15 business days (these times are shorter if you need urgent care).
- You can reach a qualified health professional by phone 24 hours a day, 7 days a week. If you need a call returned, you can expect a call within 30 minutes of leaving a message.
Health plan members have the right to appointments within the time frames in the charts below.
Urgent Care
| Urgent Care Appointments | Time Frame |
|---|---|
| Prior authorization not required by health plan | 48 hours (2 days) |
| Prior authorization required by health plan | 96 hours (4 days) |
Non-Urgent Care
| Non-Urgent Care Appointments | Time Frame |
|---|---|
| Doctor appointment with primary care physician | 10 business days |
| Doctor appointment with specialty care physician | 15 business days |
| Mental health appointment (non-physician1) | 10 business days |
| Appointment (ancillary provider2) | 15 business days |
1Examples of non-physician mental health providers include counseling professionals, substance abuse professionals and qualified autism service providers.
2Examples of ancillary services include lab work or diagnostic testing, such as mammogram or MRI, and treatment such as physical therapy.
Follow-Up Care
| Follow-Up Care Appointments | Time Frame |
|---|---|
| Mental health or substance use disorder follow-up appointment (non-physician) | 10 business days |
Learn more about the protections that most health plan members have for getting timely access to care. View this timely access webpage courtesy of the Department of Managed Health Care.
Services in Your Language
If your first language is not English, your health plan usually must give you assistance in your language at no additional cost. If you use sign language, you have the right to a sign language interpreter. You have the right to this assistance when you need to explain your health problem to your doctor, or when you need to understand your health problem, treatment choices, and important written information.
- The law says that interpretation services must be provided for your doctor visits and for other kinds of medical care (such as laboratory visits, mental health care, and more).
- Language assistance can include medical interpreters, doctors and staff who speak your language, printed materials in your language (including consent forms and treatment directions), and an interpreter for you when your child needs care.
- The interpreter may be in the room with you, or available through a telephone or video-conference system.
- You do not need to rely on family or friends to interpret for you.
- Tell your health plan and doctor that you want services in your language. Ask for an interpreter when you make your appointment.
- Ask for important information in your language. This includes consent forms, treatment plans, and information about your medicine.
“Your Right to an Interpreter” video…
Videos in: Spanish, Mandarin, Cantonese, and American Sign Language