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New doctor appointment rules take effect in California | News

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New doctor appointment rules take effect in California
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SACRAMENTO, CA - Californians who have HMOs (health maintenance organizations) and some PPOs (preferred provider organizations) are now entitled to be seen by doctors within certain timeframes.

The law kicked in Monday. Under the new wait time rules, a patient must be given an appointment to see a primary care doctor within 10 business days and a specialist within 15 days.

Another provision is that a qualified health professional must be available around the clock to help determine the urgency of a caller's health.

"The Department of Managed Health Care will audit those health plans on a routine basis, and than we'll as well be doing secret shopper audits where we call up and try to get appointments and ensure that in fact patients are getting the care that they need," said department director Cindy Ehnes.

State health officials say doctors will not be put on a stopwatch, and they can still use their clinical expertise in changing appointments if necessary. But fines and even cease and desist orders could be issued if there are ongoing and significant problems with a health care group complying with the new wait time rules.

Approximately 21 million Californians use HMOS and PPOs covered under the new rules which was signed into law last year and took effect Jan. 17, 2011.

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