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Access and Availability​

Medical Access Standards​ 

  • ​Life-Threatening Medical Problems. Members with life-threatening medical problems will have access to acute medical care with participating or nonparticipating providers 24 hours a day, seven days a week.
  • Urgent/Acute Medical Problems. Members with urgent/acute (but not life threatening) medical problems will have access to specialty-appropriate medical services with participating or nonparticipating providers within 24 hours of the request of service.
  • Non-urgent/Non-Acute Medical Problems. Members with non-urgent/non-acute medical problems will have access to a specialty-appropriate participating provider within seven calendar days of the request of service.
  • Well-Person Care or Chronic Illness Routine Evaluations. Members who need well-person care or chronic illness routine evaluations will have access to specialty-appropriate participating providers and facilities within 21 calendar days of the request for service. This standard does not apply to routine eye refractions or hearing screens.
  • Access for School Physicals. Members needing school physicals will have access to a primary care provider within 30 calendar days of request for services.
  • Waiting Room Standards. Providers will see the patient within an average of 30 minutes after the patient’s arrival for an office visit.
  • Equal Access. Participating providers or their designees (primary care and specialty) will be available for telephone consultation to members in a fashion consistent with the access granted by the provider for their patients who do not have SelectHealth insurance.
  • 24-Hour Physician Availability. Providers or their comparable covering designees will be available by telephone for emergent and/or urgent situations 24 hours a day.


Behavioral Health Access Standards

  • ​Life-Threatening Problems. Members with life-threatening behavioral health problems (crisis) will have access to acute medical care with participating or nonparticipating providers 24 hours a day, 365 days of the year. A crisis is defined as persons presenting with acute symptoms of immediate, actual, or potential danger to self, others, or property.
  • Non-Life-Threatening Problems. Members with non-life-threatening emergent behavioral health problems will have access to care within six hours. A non-life-threatening emergent behavioral health problem is defined as persons not at risk to harm themselves or others. However, if the problem is left unattended, it would exacerbate into a crisis.
  • Urgent Problems. Members with urgent behavioral health problems will have access to care within 48 hours.
  • Routine Problems. Members with routine behavioral health problems will have access to care within ten business days.
  • Waiting Room Standards. Providers will see the patient within an average of 30 minutes after the patient’s arrival for an office visit.
  • Equal Access. Participating providers or their designees will be available for telephone consultation to members in a fashion consistent with the access granted by the provider for their patients who do not have SelectHealth insurance.
  • 24-Hour Physician Availability. Providers or their comparable covering designees will be available by telephone for emergent and/or urgent situations 24 hours a day. 


Monitoring Patient Access

SelectHealth will monitor member access to care using the following methods:


  • Annual Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey. The CAHPS Survey will be used to measure compliance with accessibility to the following services:
    • Urgent medical health problems.​​​
  • Non-urgent regular or routine medical problems.
  • Member Calls. SelectHealth monitors calls to Member Services or the SelectHealth Member Advocates® team regarding access or service problems. Such inquiries or complaints are tracked and reported to the Quality Improvement committee to identify access barriers.
  • ​​After-hours access survey.
  • Appointment wait-time surveys.
  • Other methods as appropriate.​​​​

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

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