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Humana Request for Continuity of Care Form 2007-2025 free printable template
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Humana Request for Continuity of Care Form Certain medical conditions may qualify you to continue receiving treatment from your physician and to be covered by Humana at the same in-network level of benefits for a specific period of time. Examples of situations that might involve continuity of care include please check any that may apply to you or a family member Home healthcare services you are currently receiving Durable medical equipment that you are currently using Ongoing active medical...treatment such as chemotherapy dialysis hospitalization etc. Pregnancy Any of the following chronic medical conditions Diabetes Lupus Multiple Sclerosis Myasthenia Gravis Cystic Fibrosis Hemophilia Cancer Dermatomyositis Congestive Heart Failure Asthma Coronary Artery Disease Amyotrophic Lateral Sclerosis ALS Kidney Disease Chronic Inflammatory Demyelinating Polyradiculoneurophathy CIPD Other - Explain Member Information First Middle I. Last Member ID Patient Name Subscriber Name Address City...State Zip Home Phone Work Phone Birthdate MM/DD/YY Type of Plan Check one HMO PPO Name of Treating Physician Phone Number for Treating Physician Upon completion please mail form to Or fax this form to the following San Antonio Team Humana Inc. P. This form is provided as a service to you to assist you in your request for continuity of care. Complete and submit this form within thirty 30 days to initiate a review of your medical condition to determine if you qualify for Continuity of Care....Examples of situations that might involve continuity of care include please check any that may apply to you or a family member Home healthcare services you are currently receiving Durable medical equipment that you are currently using Ongoing active medical treatment such as chemotherapy dialysis hospitalization etc* Pregnancy Any of the following chronic medical conditions Diabetes Lupus Multiple Sclerosis Myasthenia Gravis Cystic Fibrosis Hemophilia Cancer Dermatomyositis Congestive Heart...Failure Asthma Coronary Artery Disease Amyotrophic Lateral Sclerosis ALS Kidney Disease Chronic Inflammatory Demyelinating Polyradiculoneurophathy CIPD Other - Explain Member Information First Middle I. Last Member ID Patient Name Subscriber Name Address City State Zip Home Phone Work Phone Birthdate MM/DD/YY Type of Plan Check one HMO PPO Name of Treating Physician Phone Number for Treating Physician Upon completion please mail form to Or fax this form to the following San Antonio Team Humana...Inc* P. O. Box 400029 1-800-266-3022 You may receive a phone call from Humana as a follow up to completing and submitting this form*. This form is provided as a service to you to assist you in your request for continuity of care. Complete and submit this form within thirty 30 days to initiate a review of your medical condition to determine if you qualify for Continuity of Care. Examples of situations that might involve continuity of care include please check any that may apply to you or a family...member Home healthcare services you are currently receiving Durable medical equipment that you are currently using Ongoing active medical treatment such as chemotherapy dialysis hospitalization etc* Pregnancy Any of the following chronic medical conditions Diabetes Lupus Multiple Sclerosis Myasthenia Gravis Cystic Fibrosis Hemophilia Cancer Dermatomyositis Congestive Heart Failure Asthma Coronary Artery Disease Amyotrophic Lateral Sclerosis ALS Kidney Disease Chronic Inflammatory Demyelinating...Polyradiculoneurophathy CIPD Other - Explain Member Information First Middle I.
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Understanding the Humana Request for Continuity of Care Form
Purpose of the Humana Request for Continuity of Care Form
The Humana Request for Continuity of Care Form is designed to assist members in maintaining their ongoing medical treatment when changes occur in their healthcare coverage. This form enables individuals to request continued access to their current providers and services at in-network benefits, ensuring a seamless transition during periods of change.
When to Submit the Form
It's essential to submit the Humana Request for Continuity of Care Form within thirty days after experiencing a significant life event, such as changing your health plan, moving to a new location, or if your current provider is no longer in-network. Timely submission helps in evaluating eligibility for continued care without interruption.
Eligibility Criteria for Continuity of Care
To qualify for continuity of care through this form, members must fall under specific categories. These include those receiving home healthcare services, using durable medical equipment, or undergoing ongoing treatments for chronic conditions such as cancer, diabetes, or other significant health issues. Documented medical necessity and the member's current treatment plan are also critical.
Required Information for the Form
When completing the Humana Request for Continuity of Care Form, members are required to provide detailed information. This includes personal identification data such as name, Member ID, and contact details, along with information on the treating physician and specifics about the current medical treatment being received.
Submission Methods for the Form
Once the Humana Request for Continuity of Care Form is completed, it can be submitted either by mailing it to the designated address or by faxing it to Humana's processing center. Members should ensure that the form is sent promptly and may want to follow up to confirm receipt.
Best Practices for Completing the Form
To enhance the likelihood of a successful request, it is recommended that members review the form thoroughly before submission. Ensuring all fields are accurately filled, providing complete documentation of treatment, and attaching any relevant medical records can facilitate a smoother review process.
Frequently Asked Questions about humana continuity of care form
What should I do if my request for continuity of care is denied?
If your request for continuity of care is denied, you may appeal the decision by contacting Humana’s customer service for guidance on the appeal process. Documentation and additional information regarding your treatment may be required.
Can I submit the form online?
The Humana Request for Continuity of Care Form typically requires submission through mail or fax. Current procedures may vary, so it is advised to check Humana’s contact resources for the most updated submission methods.
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People Also Ask about continuity of care form
What is an example of continuity of care?
For example, people with high blood pressure can check their blood pressure, and people with diabetes can measure the level of sugar in their blood. Keeping a copy of their medical record can help people participate in their health care. They can often obtain a copy from their primary care practitioner.
What is meant by continuity of care?
Continuity of care is an approach to ensure that the patient-centered care team is cooperatively involved in ongoing healthcare management toward a shared goal of high-quality medical care. Continuity of care promotes patient safety and assures quality of care over time.
What is insurance continuity of care?
What is Continuity of Care? Continuity of care for new members means that you may be able to continue seeing your current doctor or therapist for up to 12 months after you have been enrolled in a Medi-Cal managed care health plan. A Medi-Cal managed care health plan will be referred to as the “Plan.”
What is continuity of care in health insurance?
But in some cases, you may be able to keep your doctor, medical group, or hospital for a limited time. This is called "continuity of care." To receive continuity of care, you must call your health plan to ask for continuity of care. Also, your doctor, medical group, or hospital must agree to keep you as a patient.
What happens if I did not receive my 1095-A?
Q: What should I do if I don't receive a Form 1095-A? If you purchased coverage through the Marketplace and you have not received your Form 1095-A, you should contact the Marketplace from which you received coverage. You should wait to receive your Form 1095-A before filing your taxes.
What does COC mean in medical terms?
COC = combined oral contraceptive.
What is a continuation of care?
Continuity of care is concerned with quality of care over time. It is the process by which the patient and his/her physician-led care team are cooperatively involved in ongoing health care management toward the shared goal of high quality, cost-effective medical care.
How to file a claim with Humana Medicare?
How to file a Medicare claim Fill out a Patient's Request for Medical Payment form. Get an itemized bill for your medical treatment. Write a letter and add supporting documents to your claim. File your claim for Medicare reimbursement.
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