How long should I wait for a doctor's appointment?
DHCS Approved Alternative Access Standards
The state has set time and distance standards to ensure members have availability and access to covered health care services. This means that you should be able to access health care services within a specified time and distance from your home. If you live in an area that a service is not available, the state may approve alternative time and distance standards. If you have are having trouble accessing covered services, we can help. Call our Member Services team at (800) 863-4155 (TTY (800) 735-2929 or call 711)
If your zip code and provider type are listed on the approved alternate access standards, PHC must help you find an appointment. You have a right to call Member Services at (800) 863-4155 (TTY (800) 735-2929 or call 711) to get help with finding an appointment to a closer specialist. If PHC cannot find you an appointment with a closer specialist, PHC will arrange transportation to see the specialist.
To review the Department of Health Care Servies (DHCS) approvals of Alternative Access Standards (AAS) for the PHC service area - click here
Newborn Appointments
Infants discharged from hospital in less than 48 hours of life after delivery should be seen within two business days of discharge.
Non-Urgent Primary Care Appointments
These appointments include prenatal care, preventive visits, and follow-up visits. Appointments should be provided within 10 business days of the request.
Urgent Care Appointments
Appointments should be provided within 48 hours of the request.
Emergency Care
Emergency treatment must be available immediately to all members 24 hours a day. During hours when PCP offices are closed, members should be directed to an after hours or emergency care location depending on the nature of the problem.
Specialty Care
Medically necessary specialty care will be provided within the plan service area whenever possible. If a medically necessary specialty service is unavailable within the service area, plan staff will coordinate specialty care outside of the service area and/or network. Appointments should be provided within 15 business days of the request.
Non-Urgent Non-Physician Mental Health Care
Appointments should be provided within 10 business days of the request.
Non-Urgent Ancillary Services
Non-urgent appointments for ancillary services for the diagnosis or treatment of injury, illness, or other health condition should be provided within 15 business days of the request.
Preventive Dental Care
Appointments should be provided within 40 business days of the request.
Non-Urgent Dental Care
Appointments should be provided within 36 business days of the request.
Urgent Dental Care
Appointments should be provided within 72 hours of the request.
Telephone Access, Triage and Screening
Triage & screening by phone – office provides or arranges for the provision of 24/7 care or uses the Health Plan’s 24/7 triage service.
Triage & screening waiting time- not to exceed 30 minutes.
Wait time to speak to a health plan customer service representative – not to exceed 10 minutes.
If you have any problems with scheduling appointments or your doctor’s office is not meeting these time frames, please call the PHC’s Member Services Department for help. We are available Monday through Friday from 8 a.m. to 5 p.m. at 800-863-4155.
