Keeping Your Doctor
Continuity of Care
You may get a notice that your doctor or hospital is no longer in your health plan. Or you may change health plans and find out that your doctor or hospital is not in the new plan. Usually this means that you must get a new doctor or hospital.
But in some cases you may be able to keep your doctor or hospital for a limited time – a few months to a year. This is called “continuity of care.”
Can I keep my doctor?
You may be able to keep your doctor for a short time if you need care for one of the following conditions:
- An acute condition, such as pneumonia. An acute condition is serious, but it doesn’t go on for a long time.
- A serious long-term condition, such as heart disease.
- A pregnancy
- A terminal illness
- An already scheduled surgery, such as knee surgery
- Be a child under 3 years of age
What if my health plan says, “No” when I ask if I can keep my doctor for awhile?
You can file a complaint with your health plan. The number is on your membership card. Or call the Help Center at 1-888-466-2219.
Why does keeping your doctor matter?
Sometimes it is important to keep the same doctor or hospital. For example:
- Your doctor knows your disability or condition and understands your treatment.
- Scheduling surgery at a new hospital will cause delays.
How do I ask to keep my doctor?
You must call your health plan to ask if you can get continuity of care.
- You must give the name of your doctor or the hospital.
- You must explain your medical condition and treatments.
- And your doctor or hospital must agree to keep you as a patient and to accept your health plan’s payment rates.
How long can I keep my doctor?
That depends on your condition and the kinds of health plan you have. It is usually a few months to a year. If you have Medi-Cal, or Medi-Cal and Medicare, it might be different.
You can ask for a copy of your health plan’s policy on keeping your doctor. It’s called the Continuity of Care policy.
Asking for Continuity of Care
Call your health plan member service department and ask to keep your doctor or hospital.
Fill in your answers to the questions below. This will help you be prepared when you call your health plan.
- What is my condition?
- Who is the doctor I want to keep?
- If surgery is scheduled, when will it be?
- Who is the surgeon?
- What is the hospital?
- Is my doctor or surgeon willing to keep treating me for a limited time?
- Why is continuity of care important for my health?
What to say when you call your health plan
For example, you might say, “I have been seeing my doctor for 5 years. My doctor knows me well. My doctor understands my disability, and how it affects the surgery I need. That’s why I need continuity of care.”