After-Hours Requirements

Date: 08/22/17

After business hours, providers are required to offer access to a covering physician or have an answering service, a triage service or a voice message that explains to members how to access urgent and emergency care. This helps ensure our members get the best possible healthcare.

Members must be able to access their provider after normal business hours and on weekends. The requirements below ensure that our members have adequate access to needed healthcare services:

• Offices using an answering machine must:
  • Provide a message directing the member to contact 911 or go to the nearest emergency room if he or she feels it is too urgent to wait for a doctor to call back.
  • Provide instructions on how to page the doctor if the situation is urgent.
  • If the provider’s practice serves a high percentage of foreign-language speakers, the message should be recorded in both English and that language.
• Offices using an answering service must:
  • Direct the member to call 911 or go to the nearest emergency room if he or she feels it is too urgent to wait for a doctor to call back.
  • Provide an option to page or otherwise contact the provider on call with the member’s contact information. When possible, the provider must return the call within 30 minutes.
  • If the provider’s practice serves a high percentage of foreign-language speakers, the service should meet the language requirements.