Mandatory Passages and Language for MC+ Managed Care Health Plan Handbook, page 14

Regular Health Care Appointments

Your PCP must see you within 30 days when you call for a regular health care appointment. Call your health plan if you need help.

Pregnant women can see a health care provider sooner. In the first six months of pregnancy, you must be seen within seven days of asking. In the last three months of your pregnancy, you must be seen within three days of asking.

You should not have to wait longer than one hour from the time of your appointment. For example, if your appointment time is 2:00 p.m., you should be seen by 3:00 p.m. Sometimes you may have to wait longer because of an emergency. Please call your health plan if you have problems or need help with an appointment. It is always important that you take your health insurance cards to your appointments.

Urgent Health Care Appointments

Sometimes you need medical care soon, but it is not an emergency. Some examples of urgent care are:

a fever that won't go away;
earaches;
a rash that won't go away;
a pulled or strained muscle; or
vomiting or diarrhea that doesn't stop.

For urgent health care appointments, you must be seen within the following time frames:

for serious illnesses or injuries, appointments will be available at all times;
for things like a high temperature and vomiting or diarrhea that won't stop, you must be seen the same day;
for things like a rash, non-life threatening pain or fever, your provider must see you within two days.

Your PCP will treat you if he or she can. Your PCP will send you to someone else if he or she is not able to see you that soon. It is always important that you take all your health insurance cards to your appointments.

Mental Health Care Appointments

Appointments for mental health care are the same as for regular and urgent health care appointments.

You may see your health plan mental health care provider four times yearly without approval. Then after the four mental health visits, your health plan must okay more visits. Call your health plan. It is always important that you take all your health insurance cards to your appointments.

Second Opinion And Third Opinion

You may want an opinion from a different health care provider. In such cases, you must ask your PCP or your health plan to get a second opinion. Your health plan will pay for it.

You may get an opinion from a third provider if your PCP and second opinion provider do not agree. Your health plan will pay for a third opinion. It is always important that you take all your health insurance cards to your appointments.