Notice
Timely Access to Care:
Members have the right to timely access to care and telephone assistance, including the right to appointments and care within the following timeframes:
Emergency care is available 24 hours a day, 7 days per week.
Urgent care is available within 72 hours depending on individual dental needs and as required by professionally recognized standards of dental practice.
Providers must have an answering machine or answering service during non-business hours which provide instructions concerning how to obtain emergency or urgent care, including how to contact another provider who has agreed to be on-call to screen by phone or deliver emergency or urgent care.
Non-urgent appointments are available within 36 business days of the request for an appointment.
Preventative dental care appointments are available within 40 business days of the request for an appointment.
The Plan will ensure that, during normal business hours, a Customer Service Representative will answer the phone within 10 minutes.
If it is necessary for the Member or provider to reschedule an appointment, the appointment must be promptly rescheduled in a manner that is appropriate for the Member's health care needs: within 24 hours for emergency care, within 72 hours for urgent care, within 36 business days for initial/routine care, and within 40 business days for preventative care.
If the Member needs an interpreter, interpretation services are available upon request. A request for interpretation services at the time of the Member's appointment will not delay the scheduling of the Member's appointment. The Plan and provider will coordinate the interpretation services with the scheduled appointment.
Provider facilities should meet Americans with Disabilities Act (ADA) access guidelines including wheel-chair accessibility.
If appropriate care from a Plan Provider is not accessible, the Plan will refer the Member to an appropriate Non-Plan Provider. Cost-sharing will be equal to the cost-sharing the Member would have paid for similar service from a Plan Provider.
If the Member has questions about appointment wait times or if the Member would like to request an interpreter, please contact our Client Service Department at 800-443-2995.
