Plain version: a prepaid plan only works if members can actually get an appointment and can complain when something goes wrong. California sets clocks for both.

Timely access (HSC §1367.03(a)(5)): a plan's network must generally be able to offer an appointment within these times of the request: - Urgent care that needs no prior authorization: 48 hours. - Nonurgent primary care: 10 business days. - Nonurgent specialist care: 15 business days. A longer wait is allowed if the provider notes in the record that it will not harm the enrollee.

Grievances (HSC §1368.01): the plan must resolve a grievance within 30 days. When a case involves an imminent and serious threat to the enrollee's health, it gets expedited review, and the enrollee must receive a written statement on its disposition or pending status no later than 3 days from receipt.

Independent medical review (IMR, HSC §1374.30): run by the DMHC for health care service plans. It is available when a service is denied, modified or delayed because the plan found it not medically necessary. A denial because the contract excludes the benefit is a coverage decision: it can go to the department as a grievance, but not to IMR.