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What is a continuation of care approval?

Patients who are insured by a health insurance carrier are typically rendered treatment by hospitals and physicians, etc. that contract with the insurance company. They may even be "in-network" providers on your insurance plan and thus you as a patient are incented to use them. 

There are times; however, that an insurance company or a hospital or physician decides to end their contract (relationship) and that can have a significant impact on patients who may be receiving treatment from those facilities or physicians. Typically those folks being impacted will receive a letter stating when the contract will be terminated. 

You should know that you as a patient can request from your insurance company what's called a continuation of care. This means that you are requesting that because of current treatment you would like to have the insurance company continue to pay the physician or hospital under the existing contract.

This happened recently to a patient we were working with who was in the midst of chemotherapy from her oncologist. Effective October 1, the oncologist was no longer going to be 'in network' for the insurance company and this would have had negative financial implications for her and her family (with higher copays and deductibles). 

We called her insurance company and had the forms sent to her, she completed them and sent them back and waited. Fortunately, the insurance company did approve her continuation of care for six months. This 'extra' time as an in-network provider will allow her to finish her treatment without incurring too many extra costs.

Contracts between providers and insurance companies aren't often terminated, but if they are, and it poses a hardship on the patient, consider pursuing a continuation of care approval. 

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.