About 21 million Californians may be able to get a doctor's appointment sooner than they're used to. State regulators are dictating how long it should take to get care.
"It's been horrible," says HMO patient Connie Sanchez.
Like millions of Californians, Sanchez tries to get in to see her doctor as soon as she has a health issue, but it's not that easy.
"People have to wait for long periods of time, that's ridiculous," says Sanchez. "Almost 45 days was the longest I waited one time."
California became the first state in the country this week to mandate that patients with HMOs and PPOs be seen in a timely manner -- within 10 business days of making the call for most routine appointments, 15 days if it's to see a specialist. One 2009 study of the Los Angeles area found new HMO patients waited an average of 59 days for an appointment.
"Often that ends up clogging urgent care centers of emergency rooms because patients feel like they need to be seen," says Cindy Ehnes from California Department of Managed Health Care.
The mandated timeframes took seven years to develop. Doctors were worried about not having the flexibility to move appointments around for more urgent cases. In the end, it is health insurance plans that'll be responsible for tracking wait times and suffer consequences if they don't comply.
"We want the doctor to be the quarterback of medical care, not the insurer and the government. These regulations strike that balance," says Patrick Johnston from the California Association of Health Plans.
Sanchez will be starting a new job soon with different health insurance. She's excited about being able to see a doctor right away.
"If that's really the truth, that we can actually do that ... wow!" says Sanchez.
The California Department of Managed Health Care has the authority to assess fines and issue cease and desist orders. It'll be tracking consumer complaints closely and auditing health insurers to make sure those wait times for appointments go down.
