Continuing Care with Terminated Providers Clause Samples
The "Continuing Care with Terminated Providers" clause ensures that patients can continue receiving medical care from a healthcare provider even after that provider's contract with an insurance plan or network has ended. Typically, this clause allows patients undergoing active treatment, such as pregnancy or a course of surgery, to maintain their relationship with the same provider for a limited period, often until the treatment is completed or a set time has passed. Its core function is to protect patients from abrupt disruptions in care, thereby promoting continuity and stability in ongoing medical treatment during provider transitions.
Continuing Care with Terminated Providers. A. When a Preferred Provider terminates their agreement with CareFirst, for any reason except for cause, benefits will be provided for continuing care rendered by the terminated provider as described in this section. CareFirst will send a notice to the Member that the Preferred Provider is no longer available.
B. The Member may, upon request, continue to receive Covered Services from his/her provider for up to 90 days after the date of the notice of the provider termination from CareFirst provider panel, if termination was for reasons unrelated to fraud, patient abuse, incompetence, or loss of licensure status. In addition, a Member may continue treatment with a terminated provider if:
1. A Member was in an active course of treatment with the terminated provider prior to the date the Member was notified. The Member needs to request, from CareFirst, to continue receiving care from the terminated provider. Benefits will be provided for a period of 90 days from the date the Member is notified by CareFirst that the terminated provider is no longer available.
Continuing Care with Terminated Providers. A. When a Contracting Provider terminates their agreement with CareFirst BlueChoice, for any reason except for cause, benefits will be provided for continuing care rendered by the terminated provider as described in this section. CareFirst BlueChoice will send a notice to the Member that the Contracting Provider is no longer available.
B. The Member may, upon request, continue to receive Covered Services from his/her Primary Care Physician for up to 90 days after the date of the notice of the Primary Care Physician’s termination from CareFirst BlueChoice’s provider panel, if termination was for reasons unrelated to fraud, patient abuse, incompetence, or loss of licensure status. In addition, a Member may continue treatment with a terminated provider if:
1. A Member was in an active course of treatment with the terminated Contracting Provider prior to the date the Member was notified. The Member needs to request, from CareFirst BlueChoice, to continue receiving care from the terminated Contracting Provider. Benefits will be provided for a period of 90 days from the date the Member is notified by CareFirst BlueChoice that the terminated Contracting Provider is no longer available.
Continuing Care with Terminated Providers. A. When a Contracting Provider terminates their agreement with CareFirst BlueChoice, for any reason except for cause, benefits will be provided for continuing care rendered by the terminated provider as described in this section. CareFirst BlueChoice will send a notice to the Member that the Contracting Provider is no longer available.
B. The Member may, upon request, continue to receive Covered Services from his/her Primary Care Physician for up to 90 days after the date of the notice of the Primary Care Physician’s termination from CareFirst BlueChoice’s provider panel, if termination was for reasons unrelated to fraud, patient abuse, incompetence, or loss of licensure status. In addition, a Member may continue treatment with a terminated provider if: SAMPLE
1. A Member was in an active course of treatment with the terminated Contracting Provider prior to the date the Member was notified. The Member needs to request, from CareFirst BlueChoice, to continue receiving care from the terminated Contracting Provider. Benefits will be provided for a period of 90 days from the date the Member is notified by CareFirst BlueChoice that the terminated Contracting Provider is no longer available.
2. A Member who has entered her second trimester of pregnancy may continue to receive Covered Services from the terminated Contracting Provider through postpartum care directly related to the delivery.
3. A Member that was terminally ill (as defined by § 1861(dd)(3)(A) of the Social Security Act) at the time the Contracting Provider’s agreement terminated may continue to receive Covered Services directly related to the treatment of the terminal illness until the Member dies.
Continuing Care with Terminated Providers. A. When a Contracting Provider terminates their agreement with CareFirst BlueChoice, for any reason except for cause, benefits will be provided for continuing care rendered by the terminated provider as described in this section. CareFirst BlueChoice will send a notice to the Member that the Contracting Provider is no longer available.
B. The Member may, upon request, continue to receive Covered Services from his/her Primary Care Physician for up to 90 days after the date of the notice of the Primary Care Physician’s termination from CareFirst BlueChoice’s provider panel, if termination was for reasons unrelated to fraud, patient abuse, incompetence, or loss of licensure status. In addition, a Member may continue treatment with a terminated provider if: