Medical Mutual - Health Plans for Life

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Provider Accessibility Standards

Provider accessibility represents an important element of healthcare quality. Please strive for compliance with these accessibility standards so that our members may have access to needed healthcare services in a timely manner. We recognize that you may not be able to accommodate these time frames when unpredictable circumstances and emergencies occur.

Medical Provider Accessibility Standards and Related Descriptions

Type of Service

Description

Performance Goal

Emergency

Sudden, life-threatening symptom(s) or condition requiring immediate medical treatment.
Example: Major trauma injuries; chest pain; severe abdominal pain; new onset shortness of breath.

Immediate appointment or patient is directed to nearest emergency room or call 911.

Urgent

Onset of symptom(s) or health problem requiring prompt, but not immediate, medical attention.
Example: Minor trauma injuries; unrelieved fever; signs/symptoms of urinary tract infection; children with ear pain and fever.

Appointment available within 24 hours of initial request. As appropriate, member may be directed by the provider or Company's 24/7 NurseLine to seek care at an urgent care center for onset of symptoms or health problems requiring prompt but not immediate medical attention.

Routine

(ongoing, non-urgent symptoms)

Follow-up care for non-acute symptoms
Example: Visits for recurring/chronic problems.

Appointment available within 30 days.

Preventive Care

Routine, regularly scheduled health assessment.
Example: Well-child visits; routine physical or gynecological exam.

Appointment available within 30 days.

After Hours Care

Accessibility to healthcare provider outside of normal business hours.

24-hour, 7-day a week on-call coverage system where patients can speak with a healthcare provider.

Behavioral Health Accessibility Standards and Related Definitions

Type of Service

Description

Performance Goal

Non-Life
Threatening
Emergency
Services

Services provided for the onset of symptoms of behavioral health problems that require prompt attention but are not considered emergency care. Example: Suicidal/homicidal ideation without a definitive plan.

Members are scheduled to be seen within 6 hours of contacting the provider. As appropriate, members may be directed by the provider or the company's 24/7 NurseLine to seek care at an emergency department.

Urgent

Services provided for the onset of symptoms of behavioral health problems that require prompt attention but are not considered emergency care.
Example: Symptoms severely affecting daily functioning in such a way that eventual detriment to the member or others will occur.

Members are scheduled to be seen within 48 hours of contacting the provider. As appropriate, members may be directed by the provider or the company's 24/7 NurseLine to seek care at an emergency department.

Initial Visit
Routine Care

Services rendered during general office visits that are scheduled for any behavioral health concern which is of a non-emergency or non-urgent nature.

Members are scheduled to be seen
within 10 business days of contacting the provider. Excludes follow-up care for an existing problem.

Follow-up
Routine Care

Follow up care for any behavioral health concern that is of a non-emergent or non-urgent nature.

Within 30 days or as agreed upon by the member and the practitioner. Includes visit at later, specified dates to evaluate patient progress and other changes that have taken place since a previous visit.

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