California Requires Health Plans to Connect Callers to Live Agent Within 15 Minutes
California enacted legislation requiring large health care entities, including health plans, managed care organizations, PBMs, and pharmacies, to transfer callers from AI chatbots to human customer service representatives within 15 minutes upon request. The requirement applies to inquiries about medication refills, transfers, denied claims, prior authorizations, and specialist referrals. Hospitals obtained a broad exemption from the mandate. The law takes effect on a date not specified in this summary, and applies to large health care entities operating in California.
Medicaid managed care plans operating in California must implement new staffing and telephony infrastructure to ensure 15-minute live agent access, affecting operational budgets and member services compliance for high-volume call categories like prior authorizations and claims denials.
Managed Care
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