My medical group’s negotiations with a large health plan have broken down and I don’t have a current contract with them. Can I keep seeing my patients?
New provisions recently went into effect strengthening continuity of care for patients. A health plan, at the patient’s request, must provide continued coverage with the terminated provider beyond the termination date for certain acute and chronic conditions (up to 12 months), for the duration of a pregnancy, for the duration of a terminal illness, for the care of children ages 0 to 3 years (up to 12 months), and for surgeries previously authorized and scheduled to take place within 180 days of contract termination. Plans may require the physician to agree to the same terms and conditions as a contracted provider, and patients must pay the same deductibles and co-pays. Health plans were expected to file newly updated continuity of care policies, including a template of the notice they are using to inform patients of their right to completion of covered services, with the Department of Managed Health Care by March 31, 2004. For more information, go to http://www.cmanet.org/ and check ou
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