October 4, 2017

Insured by Blue Cross? You May Qualify for Continuity of Care

Mission Health is committed to ensuring that your health and wellness are not jeopardized by Blue Cross NC’s unwillingness to negotiate. Despite being out of network with Blue Cross, it is important to know that you have options to keep your doctor and your care with Mission Health. Among those options is exercising your right to “continuity of care” under North Carolina law.

What is continuity of care?

Continuity of Care is a process that allows current patients with Blue Cross insurance to continue receiving care from an out-of-network provider for ongoing special conditions.

Who qualifies?

If your primary care physician or specialist will be out of network with Blue Cross and they are currently treating you for an ongoing special condition that meets Blue Cross’ Continuity of Care criteria, you should have received a notification advising you of their Continuity of Care policy. If you did not receive a letter, please call (828) 412-6052 to see if your special circumstances apply.

It’s important to respond to Blue Cross within the timeframe noted in the letter. All applications for Continuity of Care must be in to Blue Cross NC by November 19, 2017 (December 9, 2017, for federal employees).

To be eligible for Continuity of Care, the patient must be seen by a participating provider (this includes hospital services) prior to the termination taking effect. The patient must be actively being seen by the out-of-network provider for an ongoing special condition and the provider must agree to abide by the Blue Cross’ requirements for Continuity of Care.

An ongoing special condition means:

  • In the case of an acute illness, a condition that is serious enough to require medical care or treatment to avoid a reasonable possibility of death or permanent harm
  • In the case of a chronic illness or condition, a disease or condition that is life-threatening, degenerative or disabling and requires medical care or treatment over a prolonged period of time
  • In the case of pregnancy, the second and third trimesters of pregnancy
  • In the case of a terminal illness, an individual has a medical prognosis that the member’s life expectancy is six months or less

How do you apply?

To be eligible for Continuity of Care, all Blue Cross patients must submit a Continuity of Care form. If available, we highly recommend patients speak to their employer to see if there are Continuity of Care exceptions that may be available.

To be considered, patients must do each of the following:

  1. Complete the applicable portions of the Continuity of Care form
  2. Complete the Authorization for Release of Protected Health Information form
  3. Return both forms to their Blue Cross plan

Free Continuity of Care assistance is available.

Do you have questions about continuing your current care plan? We can help! Call (828) 412-6052 Monday through Friday from 8 am to 8 pm or meet with us at Mission Health’s SECU Cancer Center, room 115, Monday through Friday from 8 am to 5 pm.

Since beginning its free service assistance to patients applying for Continuity of Care earlier this month, Mission Health has assisted more than 225 patients in applying for this benefit. Here are some of their stories:

  • A woman and her husband, both with chronic illnesses, visited the Continuity of Care help desk. One has a cardiac condition and the other is undergoing radiation therapy for cancer. Both filed Continuity of Care forms and both were approved by Blue Cross NC. Neither needs to leave their doctors they know and love.
  • A young woman newly diagnosed with multiple sclerosis visited the Continuity of Care help desk with her parents. Everything was very new and stress levels ran high. They didn’t know how to file the forms or the information they needed to provide. The social worker was able to listen, support and help submit the forms. Now the young woman’s treatment can continue at Mission Health.
  • A parent sat bedside with a child diagnosed with cancer. Mission Health’s social workers assisted the family in submitting the Continuity of Care forms, which were approved. Much to the parent’s relief, the child can continue receiving cancer treatment from Mission Health.

Still have questions?

We can help. Our community information line will return your call and answer your questions. Call (828) 412-6052.

More than 1 million western North Carolina residents are counting on Mission Health to deliver the same high quality and accessible care we’ve delivered for more than 125 years. Our patients are our No. 1 priority, and we’re fighting for our patients to ensure we can continue to deliver on those same expectations.

The Care You Need. No Matter What.

Learn more at missionstandswithyou.org.


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