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Quality

The quality of your care matters to us. Read about our appointment standards and more.

Appointment Standards

 

If you are not able to find an appointment within these time frames, please call customer service for help. You also have the right to file a grievance.

Access to Care Standards

Physical Health, Behavioral Health, and Substance Use

Type of Care Timeliness Standard
Urgent Within 24 hours of initial contact/request
Outpatient follow-up after hospitalization Within 7 days after discharge
Non-urgent, symptomatic*

*For BH, cannot consider administrative or group intake processes as a treatment appointment or place members on waiting lists for initial requests

Within 7 days of request

Physical Health Only

Type of Care Timeliness Standard
Emergency 24/7

Routine (non-symptomatic well-care physical examinations, preventive care) Within 1 month of request*

*Unless required sooner by AAP Bright Futures schedule

Behavioral Health and Substance Use only

Type of Care Timeliness Standard
Emergency (by phone) Within 15 minutes after initial contact
Emergency (in-person) Urban/Suburban areas: within 1 hour of contact Rural/Frontier areas: within 2 hours of contact

Complaints

You have a right to complain. This may also be called a grievance. You can complain if you are unhappy with your service or think you were treated unfairly. Talk to your provider first. You cannot lose your coverage for filing a complaint.

Please let us know if you are unhappy with your providers, services or decisions made about your treatment. An example of a grievance is if the receptionist was rude to you or you couldn’t get an appointment when you needed one. For details on how to file a grievance and what to expect after you file a grievance, please click here.

Appeals

You also have a right to appeal. This means you can ask for review of an action or decision about what services you get. You will not lose your benefits if you file an appeal. You may file an appeal if we deny or limit a type of service you request. You can appeal if we reduce or stop a service that was previously approved. You can also appeal if we deny payment for any part of a service. There are other actions you may appeal. To learn about those actions and how the appeal process works, please click here.