Continuity of Care: Your Rights When Your Doctor Leaves Your Insurance Network

Few situations are more disruptive than discovering that your physician has left your insurance network mid-treatment. Whether you're in the middle of cancer treatment, a high-risk pregnancy, or ongoing management of a serious condition, being forced to switch providers abruptly can be medically dangerous — and, in many cases, it's legally preventable.

Continuity of care protections give you the right to continue seeing a provider who has left your network for a transition period at in-network cost-sharing rates. Here's what the law says and how to invoke these protections.

What Is Continuity of Care?

Continuity of care protections allow patients who are in the middle of a course of treatment when a provider leaves a plan's network to continue receiving care from that provider for a limited period — typically 30 to 90 days — at in-network cost-sharing levels. In some states, protections extend longer for specific circumstances such as pregnancy.

These protections recognize that abruptly switching providers is not merely inconvenient — for patients with ongoing serious conditions, it can cause real medical harm through gaps in care, delayed treatment, loss of therapeutic relationships, and disruption of medication management.

Federal Continuity of Care Protections

ACA Marketplace Plans: CMS requires that ACA Marketplace plans provide continuity of care when a provider leaves the network. While the federal requirement focuses on notice and transition assistance, many states have enacted more specific protections.

Medicare Advantage: CMS rules require Medicare Advantage plans to provide continuity of care for up to 90 days when a provider leaves the network mid-treatment. This applies to ongoing treatment for a serious or chronic illness. The plan must cover care at in-network rates during the transition period.

No Surprises Act (2022): The Act includes provisions addressing continuity of care when a provider terminates their network participation. It requires that if a provider leaves mid-treatment, the plan must provide notice to affected patients and offer them a transition period.

State Continuity of Care Laws

Most states have enacted continuity of care laws that go further than federal minimums. While specific requirements vary, the common framework includes:

California (Health & Safety Code §1373.96): One of the strongest continuity of care laws. Requires plans to provide a transition period of at least 90 days for ongoing active treatment. For pregnancy, the protection extends through postpartum care. Plans must cover the provider's services at in-network rates during the transition.

New York: Requires insurers to provide continuity of care for at least 60 days for patients undergoing active treatment for a serious illness or complex condition.

Texas, Florida, Illinois, Virginia, Colorado, and most other states: Most have laws requiring 30–90 day transition periods with in-network cost-sharing. Pregnancy protections are typically extended through the postpartum period.

Conditions typically qualifying for continuity protections include:

• Active cancer treatment
• Pregnancy (typically extended through delivery and postpartum care)
• Serious or chronic conditions requiring ongoing specialist management
• Terminal illness
• Acute illness or injury requiring ongoing treatment
• Mental health and substance use disorder treatment in progress

When Continuity of Care Rights Are Triggered

Your continuity of care rights are triggered when:

• Your current provider terminates their participation in your plan's network
• Your plan terminates the provider from the network
• Your insurance plan changes (e.g., open enrollment, employer changes your plan)
• You move to a plan that doesn't include your current provider

Note: Continuity protections are typically stronger when the insurer removes the provider from the network (rather than the provider voluntarily leaving) because the plan has more control over the former situation.

How to Request Continuity of Care

Step 1: Act immediately when you learn of the change. Continuity of care requests must generally be submitted before the provider officially leaves the network. If your physician notifies you they are leaving your plan's network, contact your insurer within days — not weeks.

Step 2: Get a physician's statement. Your treating physician should provide documentation stating:

• The nature of your ongoing treatment
• That interrupting treatment would be medically harmful or disruptive
• The expected duration of the treatment course
• Why a transition to a different provider would be clinically problematic

Step 3: Submit a written continuity of care request to your insurer. Address it to the member services department and cite your state's continuity of care law specifically:

"I am requesting continuity of care pursuant to [State Statute/Code Section]. I am currently under the active treatment of [Dr. Name] for [condition]. I understand that [Dr. Name] will be leaving [Plan Name]'s network on [date]. Interrupting my current course of treatment would be medically harmful as documented in the attached letter from my physician. I request that [Dr. Name] be designated as a transitional care provider for a period of [90 days / through completion of treatment / through delivery and postpartum period] at in-network cost-sharing rates."

Step 4: Establish the transitional care agreement. The insurer may require your out-of-network provider to agree to accept in-network rates during the transition period. Contact your physician's office to ensure they are aware and willing to participate in the transitional arrangement.

Step 5: Appeal if denied. If the insurer denies your continuity of care request, file an internal appeal within the required timeframe. Cite the specific state law and the medical documentation supporting continuity. For urgent situations, file an expedited appeal.

For Open Enrollment and Plan Changes

Continuity protections also apply when you change insurance plans — for example, during open enrollment when your employer changes carriers, or when you purchase a new plan on the Marketplace. In these situations, most state laws provide a shorter transition window (30 days), but you are still entitled to request continued care at the in-network rate.

Before your new plan takes effect, contact the insurer and request a determination of whether your existing providers are in-network. If they are not, request a continuity of care transition period.

What Continuity of Care Does Not Cover

Continuity protections are time-limited. They do not provide permanent out-of-network coverage. After the transition period:

• You are responsible for finding a new in-network provider
• Out-of-network cost-sharing applies if you continue seeing the provider
• The plan is not required to extend the transition period indefinitely

Use the transition period to find a suitable in-network provider while completing active treatment phases with your current physician.

Fight Back With ClaimBack

If your insurer has denied a continuity of care request or is requiring you to switch providers mid-treatment, ClaimBack can help you draft a targeted appeal citing your state's specific continuity of care law and the medical necessity of maintaining your current provider relationship.

Start your appeal at ClaimBack

Related Reading

• Network Adequacy: Your Rights When Your Insurer's Network Is Insufficient
• Common Reasons Insurance Claims Are Denied
• Internal vs. External Insurance Appeal