Access To Care Standards
HMO-PPO (and all lines of business) 
PRIMARY CARE

BCBS and the Physician Advisory Group have established the following Access to Care Standards for Primary Care Physicians.

EMERGENCY CONCERN(LIFE THREATENING) SHOULD BE REFERRED DIRECTLY TO 911 OR THE CLOSEST EMERGENCY DEPARTMENT. IT IS NOT NECESSARY TO SEE THE PATIENT IN THE OFFICE FIRST.

Waiting time for appointment:

Urgent - not life threatening, but a problem needing care within 24 hours.

Pediatrics

see within 48 hours

Adult

see within 48 hours

Symptomatic non-urgent e.g. cold, no fever.

Pediatrics

within 30 days

Adults

within 30 days

Follow-up of Urgent Care

Pediatrics

within 7 days

Adults

within 7 days

Chronic care follow-up: e.g. blood pressure checks, diabetes checks.

Pediatrics

within 14 days

Adults

within 14 days

Complete Physical/Health Maintainence

Pediatrics

within 60 calendar days

Adults

within 60 calendar days

Coverage

Practice has a recorded telephone message instructing the patient to call 911 or go to the ER for any life threatening event and to refer them to the physician on-call, to an answering service, or nurse triage service.

Office Hours

Indicates the posted hour during which appropriate provider office personnel are available. (Solo doctors need to fully meet this standard individually but groups of providers may share this requirement.)

Daytime hours/weeks

7 hours per day x 5 days = 35 hours

Night hours/weekend

24 hours/day coverage
Standard: Office Hours=35 hrs/week. GOAL: 100% compliance

Definitions of "Regular" appointments:

Pediatrics:

any pediatric patient with a non-emergent, non-urgent condition being referred to a non-MD provider

Adult Sub-acute problem:

any problem which, if treated appropriately, should be of short duration

Adult Chronic problem:

any problem which will require a long period of care to reach solution

BCBS and the Physician Advisory Group have established the following Access to Care Standards for Behavioral Health Providers participating in the BCBS Network.

Average time for appointment:

Life-Threatening Emergency Seen immediately or referred to the ER
Non-life Threatening Emergency Seen within six hours
Urgent Care Seen within forty-eight hours
Initial Visit for Routine Care Seen within 10 business days
Routine Office Visit Seen within 30 business days