How do I exercise my right to "continuity of care" to keep seeing my doctor for a limited time after they leave my insurance network in California?

Under California law, you may have the right to continue seeing a doctor who has left your insurance network for a limited time if you have a qualifying medical condition. To do this, you must formally request "continuity of care" from your health plan. Here are the steps to exercise your right: Step 1: Confirm Your Eligibility First, determine if you have a qualifying condition under the law. These typically include an acute condition (a severe, short-term illness), a serious chronic condition, pregnancy (through the postpartum period), a terminal illness, or care for a child under 36 months old. Step 2: Contact Your Health Plan Immediately Call the member services phone number on your insurance card as soon as you learn your doctor is leaving the network. State that you want to request continuity of care and ask for the required forms and submission instructions. Step 3: Get a Supporting Statement From Your Doctor Ask your doctor to provide a signed letter or statement that confirms your diagnosis, your current treatment plan, and states that a disruption in care would be detrimental to your health. This documentation is crucial for your request. Step 4: Submit the Formal Request Complete the health plan's continuity of care request form accurately. Attach your doctor’s supporting statement and any other required documents. Submit the complete package to your plan by the required deadline. Step 5: Follow Up and Appeal If Necessary Your health plan must decide on your request within 30 days for non-urgent cases or 72 hours if your situation is urgent. If your request is denied, you have the right to file an internal appeal or grievance with your plan. If that fails, you can file a complaint with your plan's regulator, which is either the Department of Managed Health Care (DMHC) or the Department of Insurance (CDI). Important Details and Nuances For continuity of care to be approved, your doctor must agree to accept your health plan's payment rates and contract terms. The duration of care is limited: typically up to 12 months for acute and chronic conditions or for the duration of a specific treatment, such as pregnancy. Warnings and Limitations This right is not guaranteed for all situations and you must formally apply for it. If your doctor refuses to agree to the health plan’s terms, you will not be able to continue seeing them under this provision. Missing a deadline can result in a denial of your request. This is general information and does not constitute legal advice. For complex situations, consult with a qualified California attorney.