Continuity of Care
If Your Doctor, Medical Group, or Hospital Leaves Your Health Plan
You may receive a letter from your health plan or be told that your doctor or hospital is no longer a contracting provider with your health plan. Under certain circumstances, you may be able to keep seeing your doctor or visiting the hospital. This is known as "continuity of care." In order to receive continuity of care, you must call your health plan to ask for continuity of care and your doctor or hospital must agree to keep you as a patient.
Only people with certain kinds of health problems or conditions can get continuity of care:
| Type of Problem or Condition | How long you get continuity of care |
|---|---|
| Acute Condition (for example, pneumonia) | As long as the condition lasts |
| Serious Chronic Condition (for example, severe diabetes or heart disease) | Until you complete a course of treatment and your doctor can safely transfer your care to another doctor, up to 12 months |
| Pregnancy | During Pregnancy and immediately after the delivery (Post-Partum period) |
| Terminal Illness | As long as the person lives |
| Care of a Child under 3 years | For up to 12 months |
| An already scheduled Surgery or other Procedure (for example, knee surgery or colonoscopy) | Scheduled to happen within 180 days of your doctor or hospital leaving your health plan |
Check with your health plan to determine if you qualify for continuity of care. As part of this process, you will need to be ready to discuss your medical information, such as the name of your doctor or hospital, your medical condition and treatments you are receiving. You can also ask for a copy your health plan's policy on continuity of care at any time. If you have any problems asking for continuity of care or have any questions please contact the HMO Help Center at 1-888-HMO-2219 or TDD 1-877-688-9891.
If Your Health Plan Changes and You Lose Your Doctor or Hospital
If your health plan changes and it was not your choice to switch to a new plan, you may be able to keep seeing your doctor or visiting the same hospital. This is called "new enrollee" continuity of care. In order to qualify, you must call your new health plan to ask for continuity of care and your doctor or hospital must agree to keep you as a patient.
Only people with certain kinds of health problems or conditions can get continuity of care. Please see above.
Check with your new health plan to determine if you qualify for continuity of care. As part of this process, you will need to be ready to discuss your medical information, such as the name of your doctor or hospital, your medical condition and treatments you are receiving. You can also ask for a copy of your new health plan's policy on continuity of care at any time. If you have any problems asking for continuity of care or have any questions please contact the HMO Help Center at 1-888-HMO-2219 or TDD 1-877-688-9891.