Get the free Continuity of Care application - Blue Shield

City of Los Angeles Request for Continuity of Care Service Blue Shield of California and Blue Shield of California Life & Health Insurance Company Complete all sections and return this signed form

How to fill out continuity of care application

How to fill out a continuity of care application:

1. Obtain the application form from your healthcare provider or insurance company. You can usually find it on their website or request a copy.
2. Carefully read through the instructions provided at the beginning of the application. These instructions will help you understand the requirements and provide any additional necessary information.
3. Start by filling in your personal information, including your name, date of birth, address, and contact details. Make sure to provide accurate and up-to-date information.
4. Next, provide information about your current healthcare provider, including their name, address, and contact information. If you are changing healthcare providers, mention the reasons for seeking a continuity of care.
5. Describe your current medical condition and why it is necessary for you to continue receiving care from your current healthcare provider. Provide any relevant medical records or documents to support your claim.
6. If you have any special requirements or needs, such as specific medications, treatments, or therapies, make sure to mention them in the application. This will help your new healthcare provider understand your unique situation better.
7. Fill out any additional sections or questions specific to your healthcare provider or insurance company. These sections may include information about your insurance coverage, previous medical history, or any other relevant details.
8. Review the completed application form to ensure all the information provided is accurate and complete. Make any necessary corrections or additions before submitting it.
9. Submit the application form as per the instructions provided. This may involve mailing it to a specific address or submitting it online through a secure portal. Keep copies of the application and any supporting documents for your records.

Who needs continuity of care application?

1. Individuals who are transitioning to a new healthcare provider or insurance plan and require ongoing medical care.
2. Patients with chronic or complex medical conditions who require continuity of care from their current healthcare provider.
3. Individuals who have built a strong patient-physician relationship and want to maintain that connection for their ongoing medical needs.
4. Those who have specific treatment plans or therapies that are closely monitored and coordinated by their current healthcare provider.

Overall, anyone who values their ongoing medical care and wants to ensure a smooth transition between healthcare providers can benefit from filling out a continuity of care application.

For pdfFiller’s FAQs

What is continuity of care application?

Continuity of care application is a form used to request continued coverage for medical services from a specific provider when that provider is no longer in network.

Who is required to file continuity of care application?

Members who are currently undergoing treatment with a provider who will no longer be in network are required to file continuity of care application.

How to fill out continuity of care application?

To fill out continuity of care application, members need to provide their personal information, information about their current provider, details of the treatment being received, and reasons for requesting the continued coverage.

What is the purpose of continuity of care application?

The purpose of continuity of care application is to ensure that members can continue to receive care from a provider they have an established relationship with, even if that provider is no longer in network.

What information must be reported on continuity of care application?

Information such as member's personal details, current provider's information, treatment details, and reasons for requesting continued coverage must be reported on continuity of care application.

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