Appointment Wait Time Standards

How long should I wait for a doctor's appointment?

 

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.