Get the free Continuity of Care Request Form - Blue Shield of California

Continuity of Care Request Form Continuity of care is a process that allows continued care for members who change plans, or whose plans or provider(s) have been terminated from the participating provider

How to fill out continuity of care request

How to fill out continuity of care request

1. Obtain a continuity of care request form from your current healthcare provider.
2. Fill out your personal information including name, date of birth, address, and contact information.
3. Provide information about your current healthcare provider, including name, address, and contact information.
4. Specify the reason for the continuity of care request and the date it is needed by.
5. Sign and date the form before submitting it to your current healthcare provider.

Who needs continuity of care request?

1. Anyone who is transitioning to a new healthcare provider and wants to ensure continuity of care by transferring their medical records and treatment plans.

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What is continuity of care request?

Continuity of care request is a process by which a patient can request to continue receiving care from a particular healthcare provider or facility despite changes in insurance coverage or network.

Who is required to file continuity of care request?

Patients who wish to continue seeing a specific healthcare provider or receiving treatment at a specific facility that is no longer considered in-network by their insurance plan are required to file a continuity of care request.

How to fill out continuity of care request?

To fill out a continuity of care request, patients typically need to contact their insurance provider and request the necessary forms. They may also need to provide supporting documentation from their healthcare provider to demonstrate the medical necessity of continued care.

What is the purpose of continuity of care request?

The purpose of continuity of care request is to ensure that patients can continue to receive necessary medical treatment from a specific healthcare provider or facility without interruption, even if it is considered out-of-network by their insurance plan.

What information must be reported on continuity of care request?

Continuity of care request typically requires information such as the patient's medical history, the healthcare provider's credentials, a treatment plan, and any supporting documentation to demonstrate medical necessity.