California is first state to legislate deep cuts in wait times to see HMO doctors

The Waiting Room. CC photo: Big Grey Mare

Californians still waiting to have "no wait" legislation passed 8 years ago take effect. At least one HMO warns that patients will pay more for reduced wait times.

Waiting too long for a medical appointment? California will cut wait time to between 10 and 15 days. Unfortunately, it could take nearly a year to go into effect, nearly eight years after the no-wait law was passed by the state legislature.
“California patients are literally sick of having to wait weeks to see a doctor. What good is health coverage if a patient can’t find a doctor taking new patients or within driving distance? These new rules say that patients can reasonably expect to have timely access to needed health care.” -- Cindy Ehnes, Director of the California Department of Managed Care

After haggling for close to eight years to get a consensus on permissable wait times for getting an appointment with HMO physicians, California appears to be on the cusp of doing just that for the 20 million Californians covered by HMOs.

But even with all the rules in place, the full effect won’t take place for another nine months or a year, Los Angeles Times reporter Duke Helfand told me in an email.

Once implemented, California will be the first state to mandate how quickly HMO members will be able to see their doctors. For many it will be too late; for the rest, it can’t come soon enough.

The regulations, which could have gone into effect as of Jan. 31, were derived from the Timely Access Law passed by the State Legislature in 2002. It seems inconceivable that once the law was passed, they could have let the foot-dragging on the part of the HMOs go on for so long, but they did.

The Timely Access Law was prompted by accusations from patients covered by HMO plans that access to care was delayed because there were too few participating physicians.

Not surprising is the response by HMO providers, and if you were a good prognosticator or just knew how the system works, you could have seen this one coming from the get-go. So should have the legislators who could have written a "no stalling" clause into the bill. It's impossible to estimate how many people they hurt by not doing that.

While the HMO honchos say they support the new rules, they characteristically warned -- you could say threatened -- that because of the new rules, costs may be driven up.

They could have omitted the “may be,” because it’s a sure thing that they will use any excuse to drive up the costs to their policy holders. Health care costs have been steadily going up exponentially, far exceeding the cost of living and the raises that used to go with them. And with no governmental controls in place, they’ll continue to rise.

Ironically, this week, using rising health care costs as their excuse mantra, Anthem Blue Cross in California announced that it’s raising its rates on 800,000 non-group members from as much as 35 percent to 39 percent beginning March 1, according to Helfand's latest report in the Los Angeles Times.

Whatever their customers are paying now is too much, and with a 39 percent increase they might as well put the premium money in a savings account for everyday, minor medical expenses and see if they can find reasonable major medical only.

The no-wait plan not only covers HMO providers that include mental health, vision care and other services, but dental plan providers, too.

The limits set by the plan require that appointments for non-urgent primary care be set within 10 business days; non-urgent appointments with specialists must be made within 15 business days.

The new rules also give HMO members the rights to access to a health care professional at all times, appointments for urgent care within 48 hours of a request, and have a phone call to a doctor returned within 30 minutes.

Non-HMO plan holders will not be directly affected by the new rules.

The foot-dragging will continue as the HMOs have nine months to comply. The one stick the California Department of Managed Health Care has to beat about the heads of any intransigent HMOs is the ability to fine them if they don’t comply with the rules.

For more info:
The Doctor Will See You Now! - California shortens wait times for patient appointments (pdf of press announcement, California Department of Managed Care, Jan 20, 2010)