Continuity of Care
A new member or a member whose doctor is no longer in SFHP’s provider network may request to receive the completion of covered services being provided by a non-participating provider, if at the time of the member’s enrollment with SFHP, the member was receiving services from that provider for one of the following conditions.
These health conditions include:
- Acute illness
- Serious chronic illnesses
- Pregnancies (including immediate postpartum care)
- Terminal illness
- Children from birth to 36 months of age
- Members who have received approval from a now-terminated or non-participating provider for surgery or another procedure as part of a documented course of treatment.
For new SFHP Medi-Cal members who are classified as seniors and persons with disabilities and who are mandatorily enrolled into SFHP between June 2011 and May 2012 only: Continuity of care with a provider may be arranged for up to 12 months following enrollment provided the following conditions are met:
- Confirmation that the member has seen the non-participating provider within the 12 months prior to enrollment in SFHP by historic claims data or provider confirmation, and
- Confirmation that the non-participating provider will accept SFHP or Medi-Cal rates, whichever is greater, and
- Confirmation that he non-participating provider does not have quality of care issues
Contact SFHP’s Customer Service Department at (415) 547-7800 (local) or (800) 288-5555 to request continuity of care from a terminated provider, or a non-contracted provider.