Access is defined as the extent to which a member can obtain available medical services when he or she needs them.
Below are the expected access standards for general medical and behavioral health services provided by Paramount
physicians. If you are having problems obtaining these services, please call the Member Service Department at
1-419-887-2525 or 1-800-462-3589.
Medical |
Behavioral Health |
|
| Type of Care Required |
Standard |
| Routine assessments, physicals, or new visits |
Routine care/office follow-up visits: This type of care is generally for nonurgent,
nonemergent assessments or
visits; or posthospitalization visits for
recurring problems when the member,
Primary Care Physician, and behavioral
health provider agree with or prefer the
scheduled time. |
Members can access care within 30 days. |
| Routine follow-up visits: for recurring problems related
to chronic conditions, such as
hypertension, asthma, or diabetes |
Routine care/office visits: for new problems upon request of the
member or provider |
Members can access care within 14 days. |
| Symptomatic nonurgent visits: for conditions such as a cold, sore
throat, rash, muscle pain, or headache |
|
Members can access care within two to four days. |
| Urgent medical problems: unexpected illnesses or injuries
requiring medical attention soon
after they appear |
Urgent care: may not be life-threatening but
requires immediate attention (complex
or dual problems, such as substance
abuse and mental problems) |
Members can access care within one to two days. |
| Serious emergencies: life-threatening illness or injury,
such as heart attack, stroke, poisoning,
loss of consciousness, inability
to breathe, uncontrolled bleeding,
or convulsions |
Emergency care: immediate threat to self or others
(acutely suicidal or homicidal) |
Immediate care |
| Access to care after hours |
|
Members will find access to after-hours care to be acceptable. |
| Return phone calls from provider office during office hours |
|
Members will find return phone calls during office hours to be acceptable. |