LINCOLN (CBS13) – There are rules on how long you should wait to see your doctor. The state is supposed to enforce the rules, but we’ve just learned the state has no idea how often health plans are following them.
Shiann Hutchison says her insurer couldn’t get her in to see a doctor even after a six-month wait.
“I’m pretty much supposed to wait for this baby to drop, and hope for the best,” she said.
The only appointment she says she could get would be nearly two months later when she was 8 months into her pregnancy.
“I just want to be seen. I need to makes sure this baby is OK,” she said.
She says her insurer sent her to a clinic, but she wasn’t seen because she didn’t have her California ID that day.
That wait didn’t sit well with Linda Nguy with Western Center on Law and Poverty. She says everyone with insurance has a right to timely access to care.
“It’s appalling to me, said Linda Nguy with Health Consumer Alliance.
|APPOINTMENT TYPE||TIME FRAME|
|Urgent Care (No prior authorization required)||48 hours|
|Urgent Care (prior authorization required)||96 hours|
|Non-Urgent Doctor Appt. (primary care)||10 business days|
|Non-Urgent Doctor Appt. (specialty physician)||15 business days|
|Non-Urgent Mental Health Appt. (non-physician^)||10 business days|
|Non-Urgent Appt. (ancillary provider^^)||15 business days|
|^ Includes counseling professionals, substance abuse professionals, qualified autism service providers|
|^^ Includes lab work or diagnostic testing such as a mammogram or MRI, or treatment of illness or injury|
If it’s urgent care it’s two to four days. Non-urgent appointments are 10 to 15 business days.
In Shiann’s case, Linda says it’s 10 business days.
“Prenatal care is necessary for the health of the mother as well as the health of the child,” Linda said.
How often are health plans following the rules? We don’t know.
A state report says 90 percent of the data of the data health plans submitted to the state contained “significant data inaccuracies” making it “virtually impossible to measure individual health plan compliance.”
In the past 2-years the state has fined Healthnet, Cigna and Anthem Blue Cross for timely access to care issues.
“It’s just the tip of the iceberg,” said Linda.
Under Senate Bill 964 (2014) this is the second year requiring health plans to submit data. “And that there are inaccuracies, it’s disconcerting,” she said.
The California Association of Health Plans said in a statement, “Clearly this report demonstrates that we have work to do to improve our survey responses, and health plans are committed to working with the department to address it.”
“I’m really scared,” said Shiann, “It’s been a fight; it’s been nothing but a fight.”
But after we got involved she got in to see a doctor, and everything was fine. In December, Shiann gave birth to a healthy baby boy.
The state’s Department of Managed Health Care says it’s “frustrated.” It is going after all the health plans that failed to comply with the law.
If you can’t get you in to see a doctor within the time frame required by law, call your health plan’s customer service number and tell them the problem.
If your insurer is not helpful in getting you an appointment within the required time reach out to the Health Consumer Alliance 1-888-804-3536 or the Legal Services of Northern California 1-888-354-4474.
Here are organizations that manage your healthcare coverage, and if you have a problem you can also file a complaint with them: