Access to Care
WHPI has policies to assure our patients have access to covered
services during and after standard office hours. This includes making sure that offices provide a way for members to contact clinicians after office hours and on weekends for care or questions about a situation that is not a life-threatening emergency but still a concern.
Our policy is:
Primary care offices will provide or arrange for the provision of
covered services to members 24 hours per day, 7 days per week.
Below are descriptions of acceptable and unacceptable ways that
PCP offices may provide patient access to covered services during
non-office hours.
These approaches help ensure that the member can reach a clinician via answering service, page, etc., regarding a non-emergency issue outside of traditional office hours. Making sure that members have access to clinical services after hours, other than just going to the emergency room, is an important way to help members use their medical resources appropriately. Thank you!
| Acceptable Methods of Arranging for Primary Care
Coverage during Non-Office Hours |
| 1. Nurse/Staff Member Answers
- The regular office telephone number is answered by
an on-call, triage, or advice nurse or staff member with direct
access to the on-call primary care practitioner (PCP)
(i.e., PCP’s phone or pager number is given or they page
or call the PCP). |
| 2. Direct
Access to Primary Care Practitioner – Clinician answers
– The regular office telephone number is answered
by a PCP after hours. |
| 3. Answering Service - The
regular telephone number is answered by an answering service
which patches the call through to an on-call PCP. |
| 4. Answering
Service - The regular office telephone number is answered
by an answering service which takes a message and pages the
PCP who then returns the patient’s call. |
| 5. Answering Service -
The regular office telephone number is answered by an answering
service which patches the call through to a triage nurse who
has access to the on-call PCP. |
| 6. Answering
Service - The regular office telephone number is answered
by an answering service which instructs the member to call the
on-call PCP directly and provides a telephone number or pager
number. |
| 7. Answering Machine - The
regular office telephone number is answered by an answering
machine which instructs the member to call (not go to)
a local hospital emergency room and provides the phone number.
This option assumes the hospital has agreed to provide triage
services for the primary care office during non-office hours
and that the services of a PCP are immediately available should
they be required. |
| 8. Answering Machine - The
regular office telephone number is answered by an answering
machine which instructs the member to seek care (call or
go to) a local urgent care center. The message must include
the urgent care center’s telephone number
AND hours of operation (must give both). If
the urgent care center closes before the primary care office
re-opens, the member must be offered one of the alternative
acceptable options. |
| 9. Answering Machine - The
regular office telephone number is answered by an answering
machine which instructs the member to call the on-call PCP physician
directly and provides a telephone number or pager number. |
| 10. Answering Machine - The
regular office telephone number is answered by an answering
machine which, in addition to providing office hours and/or
instructions for receiving emergency care, instructs the member
to call an answering service and provides the phone number. |
| 11. Answering System Gives
A Number For An Answering Service - The regular office
telephone number is answered by an on-call, triage, or advice
nurse with direct access to the on-call PCP. |
| 12. Answering System Gives
A Number For An Answering Service - The regular telephone
number is answered by an answering system which provides a number
to an answering service, which in turn patches the call through
to an on-call PCP. |
| 13. Answering System Patches Call Through
to PCP - The regular telephone number is answered by
an answering system which patches the call through to an on-call
PCP. |
| 14. Answering System Gives A Number For
An Answering Service - The regular office telephone
number is answered by an answering system which instructs the
member to call the answering service and provides a phone number,
or enables the caller to call the on-call PCP and provides a
telephone number or pager number. |
| Unacceptable Methods of Arranging for Primary Care Coverage
during Non-Office Hours |
| 1. Answering Machine - An answering machine
that only takes messages. |
| 2. Answering Machine - An answering machine
with a message that recommends calling back during business hours or, if
this is an emergency, call 911. There is no mention of how to reach a PCP
if the situation is not an emergency. |
| 3. Nurse/Staff Member Answers - On-call,
triage, or advice nurse or staff member without direct access (i.e., person
doesn’t
have a way to reach a PCP – can only take message) to the on-call
PCP. |
| 4. Answering Machine - An answering machine
with a message which directs the member to go to a local emergency room. |
| 5. Answering Machine - An answering
machine which directs member to an urgent care center but does not give
the phone
number, hours of operation, or what number to call if the urgent care center
closes before the primary care office re-opens. |
| 6. An Unanswered Telephone (no
answer after 10 rings on second night attempt). |
| 7. Private Residence - Phone rings into private residence. |
We are proud of your accomplishments made toward providing WHPI
enrollees with exceptional service and encourage you and your staff
to embrace these policies. Together we
can exceed our customers' expectations!
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