Access Standards

To maintain the best possible care for our members, we have established standards — ensuring our members have continuous access to quality health care services.

Access Standards for Network Providers

We want to ensure quality standards for our providers. We promise:

  • Our network providers’ hours of operation do not discriminate against BadgerCare Plus Standard or Benchmark members
  • Translation services if a provider does not speak the member’s language

Appointment Standards

The list below are the time limits with in-network providers for scheduling medical, behavioral health, specialty care and BadgerCare Plus dental appointments.

Emergency Care

For a life-threatening situation, members are instructed to go to the nearest emergency room or call 911 for immediate medical attention

Urgent Care Clinic or Urgent Care Walk-in Clinic

Member is to call PCP’s office first to see if PCP is available. Medical attention same day, no appointment needed.

Non-urgent Sick Visit

Medical attention within two calendar days of member’s notification

Routine Primary Care Routine and/or Well-baby

Visits Visit within 30 calendar days of member’s request

Preventive Care – Immunizations, Routine Physical Exam

Visit within 30 calendar days of member’s request

High-risk Prenatal Visit Appointment

Visit within two weeks of member’s request or within three weeks if the member’s request is with a certain doctor

After-hours Access Standards — 24-Hour Accessibility

All network providers must be available, either directly or through coverage arrangements 24 hours a day, 7 days a week, 365 days a year

Primary Care Office Wait Time

Members with scheduled appointments should be seen within 30 minutes of their check-in time

Behavioral Health Initial Appointment

No longer than 10 days for an initial assessment; no longer than 30 days for members discharged from an inpatient mental health stay

Behavioral Health Urgent Care

Visit within 48 hours of member’s request

Behavioral Health Routine Appointment

Visit within 10 days of member’s request

Behavioral Health Routine Follow up Care

No longer than 30 days non psychiatric appointments and no more than 90 days for psychiatric appointments

Behavioral Health Non-Life Threatening Emergency Care

Care within 6 hours – may direct to Emergency Room

Behavioral Health Prescribing

No more than 72 hours (including weekend and holidays) for appointments with prescribing and dispensing providers for medication-assisted treatment for members with opioid use disorder (OUD)

BadgerCare Plus Routine Dental Care Appointment (such as teeth cleaning and cavity fillings)

Visit within 90 days of member’s request

BadgerCare Plus Emergency Dental Care Appointment (severe pain, swelling or bleeding)

Visit within 24 hours of member’s request