Timely access to care
California has set standards for health plans and providers to ensure members have access to health care in a timely manner. Scripps Health Plan works with our network of providers and participating medical groups (PMGs) to help you get the health care you deserve, when you need it.
|
Urgent appointment type |
Time frame |
|
Emergency & urgent care services |
Immediately, 24 hours/day, 7 days/week |
|
Urgent care (prior authorization not required by health plan)
|
48 hours |
|
Urgent care (prior authorization required by health plan) |
96 hours |
|
Non-urgent appointment type |
Time frame |
|
Non-urgent doctor appointment (primary care provider) |
10 business days |
|
Non-urgent doctor appointment (specialty physician) |
15 business days |
|
Non-urgent ancillary appointment (such as X-Ray, MRI or physical therapy, etc.) |
15 business days |
|
Behavioral appointment type |
Time frame |
|
Appointment with a mental health or substance use disorder provider who is not a physician |
10 business days |
|
Non-urgent follow-up appointment (non-physician mental health or substance use disorder providers) |
Within 10 business days of prior appointment |
Ongoing care
Preventive care services and periodic follow-up care, including standing referrals to specialists for chronic conditions, periodic office visits to monitor and treat pregnancy, cardiac, mental health, or substance use disorder conditions and laboratory and radiological monitoring for recurrence of disease, may be scheduled in advance consistent with professionally recognized standards of practice as determined by your provider.
It is important that you understand information about your health care. If you need help talking with your provider, understanding medical information or obtaining care, we can help by providing you with free interpreter (verbal) and translation (written) services. If you need language assistance or assistance making an appointment, please call Scripps Health Plan customer service at 844-337-3700 or TTY/TDD (888) 515-4065 for the hearing and speech impaired, Monday through Friday from 8 am to 5 pm PST.
For triage or screening of an urgent condition, you may call your provider’s office 24 hours a day, 7 days a week. If you contact your provider’s office after normal business hours, a qualified clinician will return your call within 30 minutes.
For treatment of mental health and substance use disorder conditions, coverage is provided through Evernorth Behavioral Health of California, Inc. Visit well.evernorth.com, or call 888-736-7009 or TTY: 711 for the hearing and speech impaired, 24 hours a day, 7 days a week, to speak with an Evernorth Behavioral Health Representative.