• BREAKING NEWS ABC shows live and on-demand -- Download the WATCH ABC app!

New Calif. law cuts wait time to see a doctor

January 18, 2011 12:00:00 AM PST
Like millions of Californians, Connie Sanchez tries to get in to see her doctor as soon as possible, but it's often not that easy."People have to wait for long periods of time," said Sanchez, an HMO patient. "Almost 45 days was the longest I waited one time."

California became the first state in the country this week to mandate that patients with HMOs and PPOs be seen in a timely manner, within 10 business days of making the call for most routine cases and 15 days to see a specialist.

One 2009 study of the Los Angeles area found new HMO patients waited an average of 59 days for an appointment.

"Often that ends up clogging urgent care centers of emergency rooms because patients feel like they need to be seen," said Cindy Ehnes of the California Department of Managed Health Care.

The mandated timeframes took seven years to develop. Doctors were worried about not having the flexibility to move appointments around for more urgent cases.

In the end, it is health insurance plans that will be responsible for tracking wait times and suffer consequences if they don't comply.

"We want the doctor to be the quarterback of medical care, not the insurer and the government," said Patrick Johnston of the California Association of Health Plans. "These regulations strike that balance."

The state Department of Managed Health Care has the authority to assess fines and issue cease and desist orders. It will be tracking consumer complaints closely and auditing health insurers to make sure those wait times go down."