Medi-Cal | Wellpoint SSB | My Health | 2014 - page 11

My Health
· 11
Communicating with your doctors
Do you have more than one doctor? Is it hard for you to keep up with the treatment
plans you’ve talked about with them? If your answer to either question is yes, you are
not alone. Having more than one doctor can get confusing, but it helps to think of your
doctors as a team.
Start by filling in the chart below with the name of your doctor and the reason for
seeing him or her:
NAME OF DOCTOR/PROVIDER REASON FOR TREATMENT/CARE
Share this list with each doctor. Work with them and let them know you expect them to
talk to each other about your health care.
Other tips for talking to your doctors
Write down a list of questions as well as all of the medications you’re taking and any
allergies you have. Bring your notes to your appointments.
Ask questions. Let your doctors know if you don’t understand something and write
down their answers.
Bring a family member or friend to your appointments. They can take notes or help
you remember what your doctors said.
Ask your doctors to write down their instructions. Call your doctors if you still
have questions.
Source: nlm.nih.gov
Times set to get care
when you need it
How long should it really take to get a doctor visit? Not long at all. The
Department of Managed Health Care requires that, as a member enrolled in
our plan, you get visits within certain time frames.
You also have access to providers 24 hours a day, 7 days a week. The goal is to
make sure you get the services you need as quickly as you can. Below is the
most current guide for care (effective January 18, 2011).
TYPES OF VISITS
TIME FRAME
Emergency exams
Immediate access 24 hours
a day, 7 days a week
Urgent exams
Within 24 hours of request
Nonurgent sick exams
Within 48 to 72 hours of
request, as needed
Routine care, nonurgent (primary care)
Within 10 business days
of request
Nonurgent care with mental health care providers who
are not doctors
Within 10 business days
of request
Nonurgent care with specialist doctors
Within 15 business days
of request
Nonurgent care for ancillary services (services for which
charges are made in addition to routine services)
Within 15 business days
of request
You should know that:
•   
Primary care providers (PCPs) are required to be available 24 hours a day by
phone, or services must be available through an on-call provider. They must
have triage and screening services. Triage is how they figure out the priority
for caring for patients based on how urgent the health problem is.
•   
If the provider or answering service is not available right away, an answering
machine may be used to tell members with emergency health care needs to
call
911
or to go directly to the nearest emergency room. The provider must
answer messages within 30 minutes.
Members also can call your health plan’s nurse line for answers about:
•   
Health concerns.
•   
Triage and screening.
•   
Prescription drugs.
•   
Local
health care services.
Where to go for the right health care services.
The waiting time for the visits may be longer if a provider needs to refer
you to someone else. It could also be longer if the treating doctor or the one
giving triage or screenings needs extra time.
•   
Providers must act within the scope of their medical license.
•   
Providers must note in the record that a longer waiting time will not harm
your health.
When you or a provider needs to reschedule an office visit, the provider
must reschedule it within a time that is right for your health care needs. The
provider must be sure care continues.
Please call us at the number on your member ID card if you have problems
getting care or services within waiting time frames.
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