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Timely access to care

California law requires health plans to provide timely access to care. This means that there are limits on how long you have to wait to get healthcare appointments and telephone advice.

Santa Clara Family Health Plan (SCFHP) is committed to providing timely access to care for all members. SCFHP strives to ensure that all health services are provided in a timely manner. SCFHP will continue to notify our members of any changes or updates made regarding the current policies.

If you have a problem getting timely access to care, please call SCFHP Customer Service at 1-800-260-2055, 8:30 a.m. to 5 p.m., Monday – Friday (except holidays). TTY users call 711.

Appointment wait times

You have the right to appointments within the following time frames:

Appointment type Must get appointment within
Urgent care appointments that do not require pre-approval (prior authorization) 48 hours
Urgent care appointments that do require pre-approval (prior authorization) 96 hours
Non-urgent primary care appointments 10 business days
Non-urgent specialist 15 business days
Non-urgent mental health provider (non-doctor) 10 business days
Non-urgent appointments for ancillary services for the diagnosis or treatment of injury, illness, or other health condition 15 business days
Telephone wait times during normal business hours 10 minutes
Triage—24/7 services 24/7 services—No more than 30 minutes
Initial pre-natal care 10 business days

Exceptions:

  • The purpose of the timely access law is to make sure you get the care you need. Sometimes you need appointments even sooner than the law requires. In this case, your doctor can request that the appointment be sooner.
  • Sometimes waiting longer for care is not a problem. Your provider may give you a longer wait time if it would not be harmful to your health. It must be noted in your record that a longer wait time will not be harmful to your health.
  • If you cannot get a timely appointment in your area because there are not enough providers, your health plan must help you get an appointment with an appropriate provider.