Appointment Wait Times

Medicare Advantage

How long should a member have to wait for an appointment?

CareFirst BlueCross BlueShield Advantage (including DualPrime, Core, and Enhanced plans) has defined timeframes with its contracted providers regarding how long a member should have to wait for an appointment. They are shown below:

• Primary Care routine and preventive care: Appointments should be provided within 30 business days.
• Primary Care services that are not an emergency or urgently needed, but require medical attention: Appointments should be provided within 7 business days.
• Behavioral health services that are not an emergency or urgently needed, but require attention: Appointments should be provided within 7 business days.
• Urgently Needed services or Emergencies: Members should be seen immediately.

¹Excerpt from MIA Regulation (2) On a semiannual basis, each carrier shall make available to its enrollees the median waiting times to obtain the following in-person appointments with a participating provider as measured from the date of the initial request to the date of the earliest available in-person appointment:

• Urgent care for medical services;
• Inpatient urgent care for mental health services;
• Inpatient urgent care for substance use disorder services;
• Outpatient urgent care for mental health services;
• Outpatient urgent care for substance use disorder services;
• Routine primary care;
• Preventive care/well visits;
• Non-urgent specialty care;
• Non-urgent mental health care; and
• Non-urgent substance use disorder care.

²Carriers shall communicate the appointment wait time standards to all covered persons in their welcome packet, and post or link the standards in online provider directory pages. The language used shall be substantially similar to the following:

Requirements for Timely Medical Appointments – District of Columbia

CareFirst members covered by their own individual or family health plan in the District of Columbia or covered by an employer plan in the District have a right to be seen by an in-network health care provider for a first appointment within a certain number of days.

A first visit with an in-network provider includes when a member:

• Schedules their first Primary Care visit with a provider;
• Changes Primary Care providers and needs to schedule their first visit with a new Primary Care provider; or
• Schedules their first visit with a provider other than their Primary Care provider, Behavioral Health / Substance Use provider, or Prenatal Care provider for specialty treatment.

How quickly can you expect to be seen? The District of Columbia’s timely medical appointments standards are detail in the table below.

If you have trouble scheduling an appointment within the timeframes listed, please call the Member Service telephone number on the back of your member ID card to speak to a CareFirst service associate. That person will help you schedule an appointment within the timeframes listed. CareFirst will assist with finding an available provider within the network.

Median Wait Times for Medical Appointments – Maryland

The following are median waiting times to obtain the in-person appointments with a participating provider as measured from the date of the initial request to the date of the earliest available in-person appointment.