California rule gives HMO patients timely health care access

The Sacramento BeeJanuary 20, 2010 

The wait may soon be over for the state's 21 million HMO members, whose doctors must comply with first-in-the-nation rules prescribing how quickly they must see patients — and even how long they can leave them holding on the phone.

The state's so-called timely access rules went into effect over the weekend after an eight-year delay during which doctors, health plans and consumer groups quibbled over details.

"It's a big victory for California consumers. These are groundbreaking consumer protections for them to get the care they need when they need it," said Anthony Wright, executive director of Health Access California.

Under the new rules, HMO physicians must see a patient who requests an appointment within 10 days. Specialists have 15 days. Urgent-care patients must be seen within 48 hours.

Telephone triage and screening services must be available 24 hours a day with a call back from a medical provider within 30 minutes. The new rules require that customers spend no more than 10 minutes on hold before they speak to an HMO customer-service representative.

"Our new regulations are going to change the landscape on how care is delivered in the state of California and probably nationally," said Cindy Ehnes, director of the state Department of Managed Health Care, which regulates managed health care plans operating in California.

Today, the average wait to see a general practitioner for a physical is 20 days in some of the state's large cities, according to a report last year by the market research firm Merritt Hawkins and Associates. In Los Angeles, the usual wait was 59 days.

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