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Continuity of Care Form
The Continuity of Care Request Form (PDF) is available to support members who are already undergoing treatment at the time their coverage begins or who experience a provider leaving the network. While the continuity of care policy itself is not new, the completion and submission of this form is now a required part of the process.
This form applies primarily to new members who, prior to their effective date, were scheduled for ongoing treatment or procedures with an out-of-network provider, including individuals in their third trimester of pregnancy. If approved, these members may receive in-network benefits for a limited transition period, generally up to 90 days, or through completion of pregnancy and postnatal care, as outlined in the Evidence of Coverage.
The form is also used when a network provider leaves the network, allowing continuing care patients to request transitional care under protections provided by the No Surprises Act.
The Continuity of Care Form is available at QualChoice.com by accessing the Find a Form or Document page from the Already a Member?, For Brokers, and For Providers sections. Please make note of this new requirement and help ensure members know when and how to request continuity of care to avoid disruptions in treatment.
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