Blue Shield of California Promise Health Plan wants to make sure you receive timely access to medical care and services. This document includes standards that are required by law, and can help you understand what to expect when you schedule medical appointments or use other health care services. If you need help making an appointment, please call us at the Customer Care number on the back of your Blue Shield of California member ID card.

Urgent care Access to care
For services that don’t need prior approval
Within 48 hours
For services that do need prior approval
Within 96 hours
Non-urgent care Access to care
Primary care appointment
Within 10 business days
Specialist appointment
Within 15 business days
Preventive care appointment
Within 30 business days
Ancillary care provider appointment
Within 15 business days for services where prior authorization has been obtained
Specialty care Access to care
Urgent specialist exam (no authorization required)
Within 48 hours of request, if no authorization is required. When a Practitioner refers a member for an urgent care need to a specialist (i.e., fracture) and authorization is not required, the member must be seen within 48 hours or sooner as appropriate from the time the member was referred
Urgent specialist exam (with authorization required)
Within 96 hours of request, if authorization is required. When a Practitioner (e.g., a referral to a specialist by a PCP or another specialist) refers a member for an urgent care need to a specialist (i.e., fracture) and an authorization is required, the member must be seen within 96 hours or sooner as appropriate from the time the referral was first authorized
Routine specialist visit, non-urgent exam
Within 15 business days
Vision care Access to care
Urgent vision services
Within 48 hours of request when it is consistent with the patient’s individual needs and as required by professionally recognized standards of vision practice
Non-urgent vision services
Within 15 business days of the request for an appointment
Preventive care vision services
Within 15 business days of the request for an appointment
Behavioral health Access to care
Emergency care
Call 911
Non-life-threatening emergency
Within 6 hours
Urgent care
Within 48 hours
Routine office visit for non-urgent appointment with a psychiatrist
Within 15 business days
Non-urgent appointment with a non-physician mental health care provider
Within 10 business days
Follow-up routine care appointment with prescriber
Within 15 business days
Follow-up routine care appointment with non-prescriber
Within 10 business days
Telephone inquiries Access to service
Access to a health professional for telephone screenings
24 hours/day, 7 days/week

 

Accessibility:

PCP: Family Medicine (General Practice & Family Practice), Internal Medicine, Pediatrics, and OB/GYNs practicing as a PCP (Medi-Cal only).

One PCP of each primary type within 10 miles or 30 minutes (or an approved/pending Alternate Access Standard) from each member’s residence or workplace in the approved service area as appropriate by age.

OB/GYN: One OB/GYN (practicing as a PCP or specialist) within 15 miles or 30 minutes from each member's residence or workplace in the approved service area.

Time standards for appointments:

The time standards for appointments may be extended when the referring, treating, or health professional providing triage services determines that a longer wait time will not have a detrimental effect on the health of the patient.

Interpreter services:

For availability of interpreter services at the time of your appointment, consult the provider directories available at blueshieldca.com or call the Customer Care number on the back of your Blue Shield member ID card.