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SENIOR CARE (COST) PLAN CONTINUITY OF CARE REQUEST From The information requested on the attached form will help us assist you as you transition your coverage under your Scott & White Health Plan

How to fill out continuity of care request

How to fill out a continuity of care request:

1. Obtain the continuity of care request form from your healthcare provider or insurance company.
2. Fill out your personal information accurately on the form, including your full name, date of birth, address, and contact details.
3. Provide your healthcare provider's information, such as their name, address, and phone number. You may need to attach supporting documentation, such as a referral letter or medical records.
4. Clearly state the reasons for your continuity of care request. Explain why it is crucial for you to continue receiving care from your current healthcare provider or specialist.
5. Include any relevant medical conditions, treatments, or medications that you are currently undergoing. This will help demonstrate the necessity of maintaining continuity in your care.
6. Indicate the duration you expect to need the continuity of care, such as until a specific date or until your condition improves.
7. Sign and date the form to certify its accuracy and completeness.
8. Submit the completed form to your healthcare provider or insurance company, following their preferred method (e.g., mail, fax, or online portal).

Who needs a continuity of care request?

1. Patients who have an ongoing medical condition or chronic illness and want to continue receiving care from their current healthcare provider or specialist.
2. Individuals who have established a trusted relationship with their healthcare provider and want to ensure continuity in their treatment plan.
3. Patients who are currently undergoing specific treatments or therapies that require consistent monitoring or follow-up care.

Remember, it is always important to consult with your healthcare provider or insurance company to understand the specific process and requirements for filling out a continuity of care request.

For pdfFiller’s FAQs

What is continuity of care request?

Continuity of care request is a process that allows a patient to continue receiving care from a particular healthcare provider even if that provider is no longer in the patient's network.

Who is required to file continuity of care request?

The patient is required to file a continuity of care request.

How to fill out continuity of care request?

To fill out a continuity of care request, the patient needs to provide details about their current healthcare provider, the reason for needing to continue care with that provider, and any supporting documentation.

What is the purpose of continuity of care request?

The purpose of continuity of care request is to ensure that a patient can continue receiving care from a specific healthcare provider despite changes in insurance networks.

What information must be reported on continuity of care request?

The continuity of care request must include information about the patient's current healthcare provider, the reason for needing continuity of care, and any relevant medical records.

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