Timely, availability of care from your primary care provider will result in swift problem identification, follow-up on previously identified issues, and appropriate use of health care resources. NAMM California's managed IPA's have established the following standards for access to care:

Access to Routine Care:

• Preventive/well care appointments or appointments to see new patients available within 30 days of call
• Non-urgent follow up appointments available within 7 days of patient's call
• Non-urgent specialty consultation appointments available within 14 days of patient's call
• Average length of waiting time in the office does not exceed 30 minutes from arrival time
• Urgent appointments available on the same business day during normal business hours
• Telephone calls will be answered in a timely manner

• Answering service with pager or person-to-person coverage 24 hours per day/
  7 days a week. If automated voice message system is used, the message must direct patient's to go to nearest emergency room in the event of a true medical emergency
• The Physician on call will respond within 30 minutes of an urgent/emergent call

NAMM California's managed IPA's base decisions regarding the provision of service on the patient's clinical condition, community standards of care and the patient's health benefit plan. Decisions are not based upon physician incentive packages, reimbursement levels or other considerations.

Many conditions require members to participate fully in their care to minimize the impact of disease on the quality of life and promote optimal wellness. Some of NAMM California's managed IPA's provide or coordinate with affiliated hospitals, several health education classes to support members in their self-care activities. In addition, NAMM California has made available Preventive Health Guidelines that are organized according to age. These guidelines outline recommended screenings and other important preventative services. Please refer to your Evidence of Coverage from your health plan to find out what services are offered and covered on your plan.

We strive to provide the best service for you and are interested in your feedback. You can submit your comments to your IPA’s Customer Service Department. If you need to file a complaint or grievance, please contact your health plan at the number listed on your ID card.

To obtain information about the hospitals and physicians that are participating with your IPA, please visit the Member homepage and then select your IPA and choose the Physician or Hospital tab at the top of the page for further information.

NAMM California's managed IPA's do not base the provision of care on ethnicity, gender, sexual orientation, race, mental or physical disability. The provision of care is based upon the member's clinical condition and the availability of benefits.

When a member has made their wishes known in regards to end-of-life care, the patient's treating physician (s) will honor the wishes as described in the advance directives. The presence of advance directives does not influence the availability or access to physicians, medical services or covered benefits except to remain congruent with the wishes stated in the advance directives. The advance directives can be revoked at any time.

When a member's active care may be disrupted by the departure of a specialty physician from the network, the member will be notified 30 days prior to the departure of the physician. The member who is impacted by this transition can call the Customer Service Department who will provide a list of suitable providers for the member's ongoing care. For members with special transition concerns, case managers will work with you and your physician(s) to develop a continuity of care plan.

The delivery of health care depends upon a mutual partnership between the member and their primary care physician. Members have certain rights and responsibilities and it is very important that as a member you know and understand them, so you can get the most out of your relationship with your doctor and be an active partner in the delivery of your health care. View the member rights and responsibilities that have been approved by NAMM’s managed IPA’s in English or in Spanish.

There are several ways to support members who may have difficulty communicating with their health care provider:

For non-English speaking members, translation services are available to assist the member. To access these services, please contact your Primary Care Physician.

For sensory impaired members, staff can provide information in a manner to accommodate the deficits. If a non-hearing member needs a sign interpreter one will be made available to the member. If the member is sight impaired, the staff will review any written information verbally. If the member has difficult understanding or needs re-enforcement, please contact your IPA's Customer Service department.

Our PCP offices are evaluated to ensure accessibility by members who might have disabilities.