If Your Doctor, Medical Group, or Hospital Leaves Your Health Plan
You may receive a notice that your doctor, medical group, or hospital is no longer in your health plan.
Usually this means that you must change doctors, medical groups, or hospitals. But in some cases, you may be able to keep your doctor, medical group, or hospital for a limited time. This is called "continuity of care."
To receive continuity of care, you must call your health plan to ask for continuity of care. Also, your doctor, medical group, 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)
|No more than 12 months – usually until you complete a period of treatment, and your doctor can safely transfer your care to another doctor
|During Pregnancy and immediately after the delivery (the post-partum period)
|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)
|The surgery or procedure must be scheduled to happen within 180 days of your doctor or hospital leaving your health plan
If Your Health Plan Changes and You Lose Your Doctor, Medical Group, or Hospital
You may also qualify for continuity of care if your health plan changes, and you are required to switch to a new plan. This is called "new enrollee" continuity of care. The rules are the same as the rules described above.
- Continuity of care is available if you get your health plan from your employer, your employer stops offering that plan and you have to change to a plan that does not have your treating doctor, medical group, or hospital.
- Continuity of care is available if you buy your own individual health plan (either through Covered California or directly from the plan) and you have to change plans because your individual health plan is no longer available in the marketplace.
Check with your health plan to find out if you qualify for continuity of care. Tell them the name of your doctor, medical group, or hospital, your medical condition, and the treatments you are receiving. If you have problems asking for continuity of care or have any other questions, please call the Department’s Help Center at 1-888-466-2219.