Preventive Care Services and Periodic Follow Up Care: Preventive care services and periodic follow up care are not subject to the appointment availability standards. These services may be scheduled in advance consistent with professionally recognized standards of practice as determined by the treating licensed health care provider acting within the scope of his or her practice. Periodic follow-up care includes but is not limited to, standing referrals to specialists for chronic conditions, periodic office visits to monitor and treat pregnancy, cardiac or mental health conditions, and laboratory and radiological monitoring for recurrence of disease.
Extending Appointment Waiting Time: The applicable waiting time for a particular appointment may be extended if the referring or treating licensed health care provider, or the health professional providing triage or screening services, as applicable, acting within the scope of his or her practice and consistent with professionally recognized standards of practice, has determined and noted in the relevant record that a longer waiting time will not have a detrimental impact on the health of the patient.
Rescheduling Appointments: When it is necessary for a provider or member to reschedule an appointment, the appointment shall be promptly rescheduled in a manner that is appropriate for the member's health care needs and ensures continuity of care consistent with good professional practice.
Advanced Access: The primary care appointment availability standard in the chart may be met if the primary care physician (PCP) office provides "advanced access.” "Advanced access" means offering an appointment to a patient with a primary care physician (or nurse practitioner or physician's assistant) within the same or next business day from the time an appointment is requested (or a later date if the patient prefers not to accept the appointment offered within the same or next business day).
WHA wants to make it easier for you to receive the right care, at the right time, and in the right place—with the best services available. The following services, when obtained from a participating provider, do not require a referral from your PCP:
WHA also offers all members access to California-licensed, registered nurses through a 247 nurse advice line. Screening, triage, and health education services are available 24 hours a day, 7 days a week. The nurse advice line can help answer questions about a medical problem you may have, including:
Interpreter services are also available upon request. Call 888.656.3574 (TDD/TTY: 711) or visit mywha.org/healthsupport to chat with a nurse or to send a secure email.
WHA and our providers support your right to obtain accessible health care. If you have needs with regard to your culture, language, or a disability, please contact your physician’s office first or call WHA’s Member Services.
If you need assistance in a language other than English, your doctor’s office and WHA offers interpretation services in many languages, including Spanish and American Sign Language, at no additional cost to you—let your physician’s office know when you call for an appointment. View the Notice of Language Assistance for more information and assistance from Member Services. The deaf and hard of hearing may use WHA’s TDD/TTY line at 711.
Additional information about access to care and how to obtain a referral or prior authorization is available at mywha.org/planbasics and your EOC.
| Urgent Care | Prior Authorization NOT required by health plan | 48 hours (2 days) |
| Urgent Care | Prior Authorization REQUIRED by the health plan | 96 hours (4 days) |
| Non-Urgent Care | Primary Care | 10 business days |
| Non-Urgent Care | Specialty Care Physician | 15 business days |
| Non-Urgent Care | Non-Physician Mental Health Provider1 | 10 business days |
| Non-Urgent Care | Ancillary Services2 | 15 business days |
| Follow-Up Care | Mental Health/Substance Use Disorder Follow-Up Appointment (non-physician) | 10 business days from prior appointment |
| Telephone Support | Telephone triage and screening services with a health professional | Wait time cannot exceed 30 minutes |
| WHA members can reach the nurse advice line 24 hours a day, 7 days a week by calling 888.656.3574 toll-free (or 711 TTY). | ||
| Telephone Support | Speak with a WHA member services representative by phone during normal business hours | Wait time cannot exceed 10 minutes |
[1] Examples of non-physician mental health providers include counseling professionals, substance abuse professionals and qualified autism service providers.
[2] Examples of non-urgent appointment for ancillary services include lab work or diagnostic testing, such as mammogram or MRI, and treatment of an illness or injury such as physical therapy.
