Access to Care Standards
To help make sure you can get the medical care you need, when you need it, we developed Physician Access Standards for in-network PCPs and Ob/Gyns who are directly under contract with us. These health care professionals follow our Physician Access Standards when scheduling appointments with you.
Emergency Care – Immediate care
Refers to a medical condition of such severity that a prudent layperson would seek immediate medical attention and care.
Urgent Care – Care within 24 hours
Refers to medically necessary care for an unexpected illness or injury.
Routine Care – Care within two weeks
Any condition or illness that does not require urgent attention or is not life-threatening, as well as routine gynecological care.
Routine Physical Exam – Care as soon as possible, but not to exceed four months from the date of your call
Refers to annual physical exams, as well as routine gynecological exams, for new and established patients.
Office waiting time
Horizon BCBSNJ’s in-network PCPs and other doctors are expected to keep office waiting room time to 30 minutes or less from the time of your scheduled appointment or when you arrive at the office, whichever is later. If your wait is longer than 30 minutes, you should be given the choice to reschedule or continue waiting.
Nights and weekends
Your PCP should be reachable 24 hours a day, seven days a week. When your PCP is not available, he or she should refer you to a covering doctor who can help you. This includes if your PCP is unavailable during his or her normal business hours.