How to See a Specialist

How to See a Specialist   |   Direct Access to Obstetrical/Gynecological Care   |   How to Obtain a Standing Referral
How to Have a Referred Specialist Designated as Your Primary Care Physician   |   How to Plan For Hospital Care
Continuity of Care

Continuity of Care

If you are in an ongoing course of treatment and:

1. your physician is no longer a participating provider because Keystone terminates its contract with that physician, for reasons other than cause; or
2. you are newly enrolled in the plan and are already in an ongoing course of treatment with a non-participating provider,

you have the option, if your physician agrees to be bound by certain terms and conditions required by Keystone, to continue your ongoing course of treatment with that physician for up to 60 days from:

• receipt of notice that the status of your physician has changed; or
• your effective date of coverage.

If you are in your second or third trimester of pregnancy at the time of your enrollment or termination of a participating provider’s contract, the continuity of care with that physician will extend through post-partum care related to the delivery.

Follow these steps to initiate your continuity of care:

• Call member services at 1-800-464-5437 and ask for a “Request for Continuation of Treatment” form.
• The “Request for Continuation of Treatment” form will be mailed or faxed to you.
• You must complete the form for yourself and send it to the patient care management department at the address that appears on the form.

If your physician agrees to continue to provide your ongoing care, the physician must also agree to be bound by the same terms and conditions as apply to participating providers.

You will be notified when the participating status of your primary care physician changes so that you can select another primary care physician.