Are You Following Ambetter Health’s Appointment Standards?

Date: 10/10/25

Do you know how long it should take for your practice to schedule a routine visit for a patient? What if it’s an emergency?

Ambetter Health reminds providers that they must adhere to the health plan’s standards for scheduling appointments with their patients, our members.

There are also standards for answering patients’ calls; different standards for primary care physicians (PCPs), obstetrician-gynecologists (OBGYNs), specialists and behavioral health providers; and specific time frames for everything from sick visits to after-hours calls to emergencies.

To review those standards, visit and bookmark Ambetter Health Provider Standards for Appointment Scheduling.

This resource also includes useful information about requesting interpreter services and telehealth options available to your patients. You can also review the standards here.

Providers can also use telehealth resources to help them meet appointment standards. Visit the Sunshine Health Telehealth Guide & Best Practices resource to learn more aboutthese services and how they can help your patients.

You can also review the Ambetter Health appointment standards here:

Ambetter Health Provider Standards for Appointment Scheduling

After Hours Availability

• All Providers (from 5 p.m. to 8 a.m. and all weekends and holidays).

After Hours Passing Standards

• Answering service or system that can contact a physician. Member should receive a response within 30 minutes.
• Advice nurse with access to physician.
• Office telephone that transfers calls to a cell phone; or any method that ensures 24-hour phone access for members.

Provider Office Wait Times

• 30 minutes maximum

Primary Care Physician (PCP)

• Urgent Visit: 24 hours
• Pediatric Sick Visit: 24 hours
• Adult Sick Visit: 48 hours
• Routine Visit: 15 business days

Obstetrician-Gynecologist (OBGYN)

• Urgent Care: 24 hours
• Routine: Within 30 business days

Specialist (includes Ancillary Providers)

• Routine Visit: 30 business days

Behavioral Health (BH)

• Non-life-threatening emergency: 6 hours
• Urgent Visit: 48 hours
• Routine Visit: 10 business days

Questions

Ambetter Health has a wealth of resources available to help answer your questions and address your concerns:

• Provider Support: Finding the Right Contact
• Provider Services: Call 1-877-687-1169
• Secure Provider Portal: Visit the Secure Provider Portal to check member eligibility, submit claims and more.
• Provider Engagement: Use the Find Your Account Manager tool to find the Provider Engagement Account Manager (PEAM) supporting your specialty and region.
• Claim Concerns: Resolve outstanding claims using the Claim Concerns form.
• Provider News: Bookmark Ambetter Health Provider News and Sunshine Health Provider News to keep up with the latest updates.
• Provider Newsflash: Subscribe to our e-newsletter to get regular updates.
• Provider Resources: Visit Ambetter Health Provider Resources to find provider manuals, important forms, scheduling standards and other provider resources.