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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.​ See the chart below for time frames of service.
Appointments ​​​Time Frame​​​​​​
Urgent Care (prior authorization ​not required by health plan) ​​48 hours​​
​Urgent Care (prior authorization required by health plan) ​​96 hours
​Non-Urgent Doctor Appointment (primary care physician)​ 10 business days
​​Non-Urgent Doctor Appointment (specialty​ physician) 15 business days
​​Non-Urgent Mental Health Appointment (non-physician1)
10 business days​
​​Non-Urgent Appointment (ancillary provider2) 15 business days​​

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

2Examples 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.
 

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