California timely access to care

Covered health care services are provided and arranged in a timely manner, as appropriate for the nature of condition, as consistent with good professional practice and meet the California standards regarding access to care.  

Medical

Appointment wait times are as follows:

• Emergency health services are available and accessible within the plan’s service area 24 hours, 7 days a week. Ambulance services for the service area served by the plan for transportation to the nearest 24-hour facility with physician coverage.
• Urgent health care services that do not require prior authorization are offered within 48 hours of the request. Urgent health care services that require prior authorization are offered within 96 hours of the request.
• Non-urgent care primary care and non-urgent, non-physician mental health services are offered within 10 business days of the request.
• Non-urgent specialist care and ancillary services (i.e. vision care services) are offered within 15 business days of the request.

Dental

Timely access to care is mandated by Title 28 CCR Section 1367.03 and 1367.031 and as specified by DMHC. Dental Benefit Providers of California members have the right to be offered appointments within the following appointment waiting times from request.

• Urgent appointments within the plan network shall be offered within 72 hours of the time of request for appointment, if consistent with the insured's individual needs and as required by professionally recognized standards of dental practice. 
• Nonurgent appointments shall be offered within 36 business days of the request for appointment. 
• Preventive care appointments shall be offered within 40 business days of the request for appointment. 
• Rescheduling of appointments within 36 business days of the request for appointment.

UnitedHealthcare monitors member access to a provider’s care through several mechanisms, including the Provider Appointment Availability Survey (PAAS). California law requires that the health plans survey their network providers annually to ensure they comply with California time-elapsed standards for urgent and non-urgent appointments.

UnitedHealthcare has contracted Sutherland Healthcare Solutions to administer the PAAS. UnitedHealthcare will assess provider compliance through the PAAS and report the results to the California Department of Managed Health Care (DMHC) and to the California Department of Insurance (CDI).

UnitedHealthcare is required to maintain networks sufficient to meet urgent care and non-urgent appointment availability standards. Using the PAAS methodology designed by the State of California, participating providers’ offices are called within normal business hours and asked when the next available appointment for urgent and non-urgent care would be. The providers’ responses to these survey questions are measured against appointment time-elapsed standards defined by the State.

Find below the 2023 PAAS results reported by license and network.

For more information on the PAAS please visit the California Department of Managed Health Care’s website: www.dmhc.ca.gov

Telephone triage/Nurse lines

Telephone triage or screening services are provided in a timely manner appropriate for the insured's condition. During normal business hours, the waiting time for a plan member to speak by telephone with a customer service representative knowledgeable and competent regarding the plan member’s questions and concerns will not exceed ten minutes. 

Language assistance

Interpreter services will be coordinated with scheduled appointments for covered health services in a manner that ensures interpreter services will be available at the time of the appointment.