Timely Access to Care

EYEXAM of California, Inc. complies with California law to provide timely access to care.  EYEXAM has established the following time frames for appointment wait time and enrollee services:

* EYEXAM does not require any prior authorization for services 

New Members/Routine Examinations- Routine examinations for new or returning enrollees will be scheduled within seven calendar days of the initial request for an appointment.

Urgent Care- Urgent care appointments will be scheduled within 48 hours.

Emergency Care- Emergency care appointments will be scheduled within 24 hours.

Follow-up Care- Enrollees who have been recommended to return for follow-up care will be scheduled within two calendar weeks (15 calendar days) of the appointment for which follow-up care was recommended, or as otherwise directed by the optometrist.

Rescheduling of Appointments- When it is necessary for a provider or an enrollee to reschedule an appointment, the appointment will be promptly rescheduled in a manner that is appropriate to the enrollee’s health care needs, and which ensures continuity of care consistent with good professional practice and the Plan’s standards of accessibility.

Interpreter Services- Interpreter services will be coordinated with scheduled appointments and walk-in appointments in a manner that ensures the provision of interpreter services at the time of appointment.

After-Hours Services- Each Plan office will maintain an after-hours voice mail advising enrollees of the office address and the hours that optometric care is available. In the case of an emergency, enrollees will be advised to contact their personal physician, their nearest emergency medical facility, or to use appropriately the “911” emergency response system.

Member Services- Member service representatives will be available at Plan offices to answer enrollee questions during normal business hours. The waiting time for an enrollee to speak with a Plan member service representative knowledgeable and competent regarding the enrollee’s questions will not exceed ten minutes. Enrollees may also contact the Plan Grievance Coordinator during or after hours by telephone or electronic mail.  Inquiries received after hours will be responded to by a Plan member service representative the following business day.

Location of Plan Offices- The location of Plan offices providing vision services shall be within reasonable proximity of the business or personal residence of enrollees, and so located as to not result in unreasonable barriers to accessibility. The service area for each office is defined to include all geographic areas within fifteen (15) miles or a thirty (30) minute drive from the location.

Ratio of Plan Providers- The ratio of enrollees to staff, including health professionals, administrative and other supporting staff shall be such as to reasonably assure that all services offered by the Plan will be accessible to enrollees in a timely manner, appropriate for the nature of the enrollee’s condition and consistent with good professional practice.