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Access issues? Member Access Program is here to help!

Did you know that HAP has standards for how long you should have to wait for medical treatment? For example, the standard for a routine visit for conditions that are not life threatening but have symptoms that require quick care or diagnosis (like a sore throat or infection) is four days. For an urgent care situation our access standard is same or next day. For emergency, the standard is immediate attention. When you are nonsymptomatic and require an office visit (such as an annual check-up or follow-up appointment) our guideline for service is within 30 days. These standards exist to ensure you have access to care when you need it. We are here to help in those cases when you need to see a doctor within these guidelines and your physician is not available.

In many cases, HAP physicians often arrange their schedule to make sure appointments are available so their patients can receive care when they need it. HAP is here to make sure that you are able to access medical care while mapping out the process and helping you along the way.

Here are some tips for receiving sick care when you need it:

• Call your PCP's office!

  • Even if the office is not open, instructions for how to receive care are given on an after-hours recording or with an answering service.

• Make sure you speak with the triage nurse.

  • A nurse is available in every physician's office to find out what your condition is and make an assessment to determine your medical need.

• If your PCP isn't available, alternatives will be offered.

  • Every PCP has a back up physician for times when they are not available (for example if they are on vacation).  In addition, HAP has urgent care locations located throughout the service area.

HAP can help you if you feel the services or appointment you received are not within the access standards. When you call the Physician Selection Line you may be asked the following questions:

• Do you have a PCP?  If you don't we'll assist you in finding a PCP that meets your needs.

• What is the medical issue and how long has it been happening?

• What was the earliest visit offered to you?

• Did you speak with a triage nurse?

Our Physician Selection Specialists will help you by working with your physician's office, a back up physician or by redirecting you to another physician that can see you within the guidelines. If you need urgent care, you may be directed to the nearest urgent care facility. If you don't have a PCP, our Physician Selection Specialists can help you find one that meets your criteria. You may reach a Physician Selection Specialist toll-free at (888) 742-2727.

If you see a back-up physician, make a follow up appointment with your PCP. If you need to reschedule or cancel an appointment, call 24 hours in advance. It's important to know that if you do not show up for an appointment that you haven't cancelled you are responsible for any payment.