Access to Care

When you access physical, behavioral, and dental care at the right place and time, it helps you stay healthy. Your providers can find and treat issues earlier. This can lead to better outcomes.

Choose a provider who can be a good partner in your care. Trillium is here to help connect you to the right provider. We also want to make sure that you receive services and supports in a way that respects your culture. We want to make sure that all communications (verbally/written) are in a language that you understand.

Trillium provides timely access to care and covered services, 24 hours a day and 7 days a week, when you medically need it. You can call Trillium if you need help getting care.

There might be a time that you need specialty behavioral health services. These services offer more intensive care programs than you can get at an office, hospital or residential care setting. These services support you with challenges like quitting street drugs or dealing with traumatic events. Specialty behavioral health services are available to all members when they need them. Some members are eligible to access the services immediately based on need.

This chart shows the timeframes when you should expect to receive care:

Type of care you need	How urgent you need it	When you should expect to be seen
Physical Health Care	Emergency	You should be seen right away at your provider’s office, or referred to an emergency department.
Physical Health Care	Urgent	You should be seen within 24 hours or as needed, based on initial screening at your providers office.
Physical Health Care	Well Care and Routine	You should have an appointment to be seen within four weeks.
Dental Health Care	Emergency	You should be seen or treated within 24 hours when you go to the Emergency Department.
Dental Health Care	Urgent	You should have an appointment within one week or as needed based on initial screening by the dental office.
Dental Health Care	Routine	You should have an appointment within eight weeks, unless there is a special health reason that makes a wait of longer than eight weeks okay.
Dental Health Care	Routine – Pregnant	You should have an appointment within four weeks for initial dental screening or exam, or routine dental care.
Behavioral Health Care	Emergency	Go to a crisis center or emergency department right away.
Behavioral Health Care	Urgent	Call your behavioral health provider to be seen within 24 hours. If they cannot get you in, go to a crisis center or emergency department.
Behavioral Health Care	Routine	Call your behavioral health provider to set up an appointment. You should receive an assessment within seven days of asking for an appointment.
Specialty Behavioral Health Services for Prioritized Population: Women who are pregnant, Veterans and their families, Women with children, Unpaid caregivers, Families, Children ages birth to five years, Persons with HIV/Aid Persons with tuberculosis, Persons who are at risk of first episode psychosis, or Persons who have an Intellectual/developmental disability	Immediately	Call the Specialty Behavioral Health Provider. The provider will set up an assessment and help you enter a program. If they do not have an opening, we can help arrange other types of services while you are on the waitlist. You should expect to be in the program within 120 days of being put on the waitlist. If you need help or encounter a delay, please call Trillium and ask to speak with a Behavioral Health Care Manager.
Specialty Behavioral Health Services for:Intravenous (IV) Drug use, including heroin	Immediately	Call the Specialty Behavioral Health Provider. The provider will set up an assessment and help you enter a program. You should be admitted to the residential level of care within 14 days of request. If they do not have an opening, we can help arrange other types of services while you are on the waitlist. You should expect to be in the program within 120 days of being put on the waitlist. If you need help or encounter a delay, please call Trillium and ask to speak with a Behavioral Health Care Manager.
Specialty Behavioral Health Services for: Opioid use disorder	Urgent	Call the Specialty Behavioral Health Provider. The provider will set up an appointment within 72 hours to do an assessment. They will also help you enter a program for opioid use disorder. If they are do not have opening or are delayed for any reason, call Trillium and ask to speak with a Behavioral Health Care Manager.
Specialty Behavioral Health Services for: Medication Assisted Treatment (MAT)	Urgent	Call the Specialty Behavioral Health Provider who will set up an appointment in less than 72 hours to do an assessment. They will also help you enter the program. The assessment will include: A full physical and other assessments that review your biological, psycho-social, and spiritual needs. The provider will review the completed assessments to figure out the best medication to use to avoid risk or harm that may occur without knowing more about you. The provider will set you up with at least two follow-up appointments one week after your assessment and entry into the program. Please call Trillium, if we have not called you on your need for MAT, as we can help you with other types of services that include: Intensive Care Coordination (ICC) Services that we offer at our health plan. Coordination of your care while you wait for assessment and entry into a program. This includes access to alternate care through community resources like a hospital, other type of provider setting, or a peer support specialist. The provider who is working with you until you are in the program sees you daily. They ensure you have access to needed medication until you are in the program. Trillium and your provider will not ask you to detox before you are assessed for entry into the program.
Specialty Behavioral Health Services for: Children ages birth to 21 years of age with serious emotional disturbances	Immediately	Call the Specialty Behavioral Health Provider who will set up an immediate assessment. They will also help you enter into a program. If they are do not have an opening or are delayed for any reason, call Trillium and ask to speak with a Behavioral Health Case Manager.