Continuity of Care
If Your Doctor, Medical Group, or Hospital Leaves Valley Health Plan (VHP)
You may receive a notice that your doctor, medical group, or hospital is no longer with VHP.
Usually this means that you must change doctors, medical groups, or hospitals. But in some cases, you may be able to keep your doctor, medical group, or hospital for a limited time. This is called "continuity of care."
To receive continuity of care, you must obtain written Prior Authorization from VHP. This authorization will specify the predetermined duration for continued care. Also, your doctor, medical group, or hospital must agree to keep you as a patient.
Only people with certain kinds of health problems or conditions can get continuity of care:
| Type of Problem or Condition | How long you get continuity of care |
| Acute Condition (for example, pneumonia) | As long as the condition lasts |
| Serious Chronic Condition (for example, severe diabetes or heart disease) | No more than 12 months – usually until you complete a period of treatment, and your doctor can safely transfer your care to another doctor |
| Pregnancy | During Pregnancy and immediately after the delivery (the post-partum period) |
| Maternal Mental Health | Shall not exceed 12 months from the diagnosis or from the end of pregnancy, whichever occurs later |
| Terminal Illness | As long as the person lives |
| Care of a Child under 3 years | For up to 12 months or 12 months from the effective date of coverage for a newly covered member |
| An already scheduled surgery or other procedure (for example, knee surgery or colonoscopy) | The surgery or procedure must be scheduled to happen within 180 days of your doctor or hospital leaving your health plan |
If you are new to VHP and you lose your doctor, medical group, or hospital from previous health plan
You may also qualify for continuity of care if your health plan changes, and you are required to switch to a new plan. This is called "new member" continuity of care. The rules are the same as the rules described above.
- Continuity of care is available if you get your health plan from your employer, your employer stops offering that plan and you have to change to a plan that does not have your treating doctor, medical group, or hospital.
- Continuity of care is available if you buy your own individual health plan (either through Covered California or directly from the plan) and you have to change plans because your individual health plan is no longer available in the marketplace.
Continuity of Care Request Process
To apply for continuity of care covered services, please contact Member Services at (888) 421-8444 (toll-free) within 30 days of your VHP coverage effective date, or within 30 days of receiving notice that your Plan Provider has terminated or notified you of their termination. For those who are hearing or speech impaired, please dial 711 or the appropriate CRS number for your modality.
For more details, please refer to the Continuity of Care Policy and Procedures.
To download a copy of the request form, click here: Continuity of Care Request Form.