Fully Integrated Duals Advantage (FIDA)
Medicare Medicaid Plan (MMP)

Access and Availability Standards

The following guidelines will help you know when you can expect to be seen by a doctor. It's important to know what symptoms need immediate attention, and when a non-urgent visit is right for you. If you are not sure, please check with your doctor. We want to make sure you have the care you need, when you need it.
Situation  Timeframe
Emergency Care Immediately upon presentation
Urgent Care Visit Within 24 hours of request
Non-Urgent "Sick" Visit Within 48-72 hours of request
Routine Non-Urgent Preventative Visit Within 4 weeks of request
Specialist Visit (Non-Urgent)  Within 4 weeks of request
Mental Health or Substance Abuse Follow-Up Visit After an Emergency or Hospital Discharge Within 5 business days (or sooner, if clinically indicated)
Non-Urgent Mental Health or Substance Abuse Visit Within 2 weeks of request (or sooner, if clinically indicated)


The average time you may expect to spend in the waiting room for a routine visit is no more than 30 minutes, and no more than one hour if your doctor's office is treating another patient with an unexpected urgent or difficult medical need. As always, if you have a serious emergency, call 911 or go to the nearest emergency room. If you are not sure if you need to go to the ER, call your Care Manager of the 24-Hour Nurse Advice line at 1-800-247-1447.


Questions? Call our Participant Services Department at 1-800-247-1447 (TTY: 1-800-695-8544). From October 1 to February 14, our office hours are 8:00 a.m. to 8:00 p.m. seven days a week and from February 15 through September 30, our office hours are Monday through Friday, 8:00 a.m. to 8:00 p.m.


(Updated 9/28/2016) H1916_FC FIDA 16011 Pending