PURPOSE OF CONTINUITY/TRANSITION OF CARE
The Transition Assistance Program provides a process that allows continued care for members when:
- Their
Primary Medical Group (PMG), Independent Physician Association (IPA),
Preferred Provider Organization Provider (PPO Provider), Hospital, or
other provider is terminated from the Anthem Blue Cross participating
provider network.
- They are a new enrollee in an Anthem Blue
Cross plan (except members with an Individual contract) and their
treating provider is not part of the Anthem Blue Cross participating
provider network.
- Continuity of care is at risk for reasons over which the member has no control. (Members who have elected to make changes in their coverage which cause them to be out-of-network are not eligible for this program).
Please Note: If
you require ongoing care for any chronic condition and you are not in
an acute phase of your illness, one requiring a special course of
treatment, you should select an in-network provider to meet your
ongoing health care needs and you do not need to complete this form. If
you need assistance selecting a new provider you should contact Anthem
Blue Cross Customer Care.
COMPLETING THE CONTINUITY/TRANSITION OF CARE REQUEST FORM
You may request Continuity/Transition of Care:
- If
you are in an active course of treatment for an acute medical condition
or a serious chronic condition. An acute medical condition is a medical
condition that involves a sudden onset of symptoms due to an illness,
injury or other medical problem that requires prompt medical attention
and that has a limited duration. A serious chronic condition is a
medical condition due to a disease, illness, or other medical problem
that is serious in nature and that persists without full cure or worsens
over time or one that requires ongoing treatment to maintain remission
or prevent deterioration. Completion of covered services may be provided
for a period of time necessary to complete a course of treatment and to
arrange for a safe transfer to another provider;
- If you are in an active course of treatment for any behavioral health condition;
- If you are pregnant, regardless of trimester;
- If you have a terminal illness;
- If
you have a newborn child between the ages of birth and 36 months.
Completion of covered services may be provided for a period of time
necessary to complete a course of treatment and to arrange for a safe
transfer to another provider;
- If you have a surgery or other
procedure that has been authorized by the previous plan or its
delegated provider and is scheduled to occur within 180 days of the
effective date of coverage for a newly covered enrollee.
If
one or more of the above situations applies to you and you would like
to see if you are eligible for the Transition Assistance Program,
please:
- Call the Customer Care Number on the
back of your UC SHIP card or the Customer Care number provided to you in
by the campus and they will assist you with completing your request
over the phone.
- Or, fax this completed request form to 1-877-214-1781.
To help ensure that your care is not disrupted, please complete the entire form below. Only complete this form if you are receiving ongoing care or are scheduled for care.
Medical Care.
- If
you are changing to a PPO or EPO and your current medical provider is
in our network, or if you are changing to an HMO and will stay in your
current PMG or IPA, you do not need to complete this form.
- If you are in a HMO and your provider is leaving the PMG/IPA, you do not need
to complete this form, you need to contact your PMG/IPA and they will
assist you with your transition to a contracting provider;
Behavioral Health Care:
- If you are changing plans and your provider is not in the Anthem network, please download and complete this form.