Common use of Transition of Services Clause in Contracts

Transition of Services. We shall notify new members and current members of the availability of transitional services for conditions that require ongoing course of treatment. New members must request the option of transitional services in writing, within 15 days after receiving notification of the availability of transitional services. Members whose physician leaves the network of health care providers shall request the option of transitional services in writing within 30 days after receipt of notification of termination of the physician. Within 15 days after receiving such notification from the member, we shall notify the member if a denial is issued for the member's request of transitional services based on the member's physician refusing to agree to accept our plan's reimbursement rates, adhere to our plan's quality assurance requirements, provide our plan with necessary medical information related to the member's care, or otherwise adhere to our plan's policies and procedures. The notification shall be in writing and include the specific reason for such denial.

Transition of Services. We shall notify new members and current members of the availability of transitional services for conditions that require ongoing course of treatment. New members must request the option of transitional services in writing, within 15 calendar days after receiving notification of the availability of transitional services. Members whose physician leaves the network of health care providers shall request the option of transitional services in writing within 30 calendar days after receipt of notification of termination of the physician. Within 15 calendar days after receiving such notification from the member, we shall notify the member if a denial is issued for the member's request of transitional services based on the member's physician refusing to agree to accept our plan's reimbursement rates, adhere to the our plan's quality assurance requirements, provide our plan with necessary medical information related to the member's care, or otherwise adhere to our plan's policies and procedures. The notification shall be in writing and include the specific reason for such denial.