SACRAMENTO (CN) – Kaiser and other so-called health maintenance organizations will be required to return calls within 30 minutes and set doctor appointments promptly. This has traditionally been a problem at Kaiser where the insurer delays appointments with specialists often for months at a time. California is the first to put time limits into place.
HMOs will be given nine months to submit plans to the California Department of Managed Health Care that meet the new guidelines, and then until January 2011 to comply. After that, the managed healthcare department may penalize HMOs that fail to ensure timely care. Complaints about delays will be a large measure of these failures.
Under the new rules, patients must be seen by a general doctor within ten business days of requesting an appointment. For specialists, the limit is two weeks. Doctors must return a patient’s call within 30 minutes and be available 24 hours a day. People with urgent needs must be seen within 48 hours.
HMOs contend that they face pressures to find enough doctors to serve an increasing number of members. A dearth of physicians, especially in rural areas, drives up wait times, they say.
Under the rules, HMOs will be granted exceptions where there are doctor shortages. Also, doctors may use their professional judgment to determine that a delay will “not have a detrimental impact on the health of the enrollee.”
The rules also apply to HMO plans that provide dental, vision, chiropractic, acupuncture and mental health care, but the wait times may be different.