Timely Access

The California Department of Managed Health Care (DMHC) requires health plan members to be seen in a timely manner. The primary intent of these regulations and the underlying legislation is to ensure that the VHP network of providers has the capacity and availability to provide care to you within certain timeframes for the various levels of care. However, sometimes waiting longer for care is not a problem. Your physician may give you a longer wait time if it would not be harmful or your health. It must be noted in your record that a longer wait time will not be harmful to your health.

Please take time to read the following California Timely Access Standards.

Appointment Scheduling

 

Waiting Time

Emergency Services

Immediately

Urgent Care appointments that do not require prior authorization from a Primary Care Physician (PCP)

48 hours of request

Urgent Care appointments that require prior authorization

96 hours of request

Non-urgent appointments with a PCP

10 business days of request

Non-urgent appointments with a Specialty Care Physician (SCP) including Obstetrical Care

15 business days of request

Non-urgent appointments for Ancillary Services (for diagnosis or treatment of injury, illness or other health condition)

15 business days of request

Office/Clinic Wait Time (From appointment registration time to when seen by the practitioner/doctor)

30 minutes (VHP Standard)

Availability of Behavioral Health Care Practitioners

Waiting Time

Life-threatening emergency

Immediately

Non-life threatening emergency

6 hours

Urgent Care appointments

48 hours of request

Non-urgent appointments with a non-physician Behavioral Health Care Practitioner (Psychologist, MFT, LCSW) includes Psychiatrists

10  business days

Office/Clinic Wait Time (From appointment registration time to when seen by the practitioner/doctor)

30 minutes (VHP Standard)

After-Hours Care

Availability

24/7 Nurse Advice Line

Employer Group Members:

Call 1.866.682.9492 (toll-free) including holidays and weekends.

Covered California and Individual & Family Plan Members:

Call 1.855.348.9119 (toll-free) including holidays and weekends

MDLive Telehealth Benefit

Visit www.mdlive.com/VHP or call 1.888.467.4614 (toll-free) to activate your account or schedule an appointment (language assistance is available).

VHP would also like to advise you that it is important for you to receive a call back from your health professionals and practitioners. If you are unable to directly reach your health care provider, the law requires you to be told, by live operator or recorded message, how long it will take to get back to you.

For triage and screening services, health plans are required to provide 24/7 triage or screening services for you by telephone. Waiting times for triage or screening services may not exceed 30 minutes. However, the waiting time must be appropriate for the problem and if that problem is urgent, a plan’s screening and triage must respond more quickly.

Lastly, VHP continues to provide health care advice through the 24/7 Nurse Advice Line including holidays and weekends. Employer Group Members can call 1.866.682.9492 (toll-free) and Covered California and Individual & Family Plan Members can call 1.855.348.9119 (toll-free).

The MY2020 Provider Appointment and Availability summary report shows how VHP's Contracted Providers are meeting timely access standards. You can review and download a copy of the report, per DMHC requirements. 

For more information, please visit www.valleyhealthplan.org to review the Combined Evidence of Coverage (EOC) and Disclosure Form, call your health care provider, or contact VHP Member Services at 1.888.421.8444 (toll-free)

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