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You are Entitled to Timely Access to Practitioners

UPMC Health Plan and UPMC Health Plan Behavioral Health Services work together to make sure that members get behavioral health appointments in a timely manner and that they have quick access to UPMC Health Plan Behavioral Health Services by telephone.

We have adopted access standards for behavioral health appointments that meet or exceed state and national guidelines. UPMC Health Plan members are entitled to:

• Appointments for routine behavioral health services within seven calendar days.
• Services for urgent needs within 24 hours.
• Non-life threatening emergency services within one hour.
• Immediate emergency services in life threatening situations.

In 2006, UPMC Health Plan Behavioral Health Services practitioners met the appointment standards for urgent, non-life threatening emergency, and emergency situations 100% of the time according to calls made to UPMC Health Plan Behavioral Health Services.

Access to routine behavioral health appointments is measured by two questions on the annual member satisfaction survey. 81. 8% of members reported that they usually or always got an appointment as soon as they wanted. 64.3% of members reported that they were seen within seven calendar days when they attempted to make an appointment for routine care.

Interventions designed to increase access to behavioral health services include:

• Publishing our access standards on a semi-annual basis in the Provider Newsletter.
• Posting articles about access on our provider website as well as on this member website.
• UPMC Health Plan Behavioral Health Services care management staff are always available to assist members in scheduling appointments, including three way calls with the member and practitioner.

To serve our members better, we also measure how quickly we answer the telephone and what percentage of callers hang up before their calls are answered. UPMC Health Plan Behavioral Health Services exceeded its goals for both of these measures in all four quarters of 2006. However, we continually strive to improve our telephone responsiveness.

If you have trouble scheduling appointments soon enough to meet your needs, please inform UPMC Health Plan Behavioral Health Services by calling 1-888-251-0083. TTY users can call 1-877-877-3580. We can offer additional referrals and/or assistance in obtaining appointments.

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