Continuity of Care
Policy Number: GP-X-013
Last Updated: Feb. 6, 2023
If a provider’s in-network status is terminated (either by Blue Cross and Blue Shield of Nebraska (BCBSNE) or at the provider’s request), BCBSNE will continue to provide benefits for a specified period after that termination to members who are actively receiving certain types of care (see chart below). The provider is contractually obligated to render covered services and will be reimbursed at the previously contracted rates. The provider should not balance bill the member for these services.
| Service | Time covered |
|---|---|
| Inpatient hospitalization | Up to 90 days following discharge date |
| Non-surgical cancer treatment | Up to 90 days or a complete cycle of radiation or chemotherapy, whichever is greater |
| Surgical cancer treatment | Up to 90 days following surgery date |
| End-stage kidney disease and dialysis | Up to 90 days after initiation of continuity of care |
| Symptomatic AIDS undergoing active treatment | Up to 90 days |
| Recent bone marrow or organ transplant (or on the waiting list) | Up to 180 days |
| Pregnancy | Up to six weeks after delivery date (after first trimester) |
| High-risk pregnancy | Up to 90 days following delivery date |
| Mental illness and/or substance abuse (inpatient or outpatient) | Up to 90 days |
| Terminal illness undergoing active treatment | Up to 90 days |
| Non-elective surgery | Up to 90 days following surgery date |
| Serious and complex condition undergoing active treatment | Up to 90 days |
| Circumstances where BCBSNE is required by applicable law to provide transition coverage of services being rendered by a provider after the provider leaves the network accessed by the member’s benefit plan. | |
The member must complete the Application for Continuity of Care to determine eligibility for receiving in-network benefits for the conditions/timeframes listed above.
BCBSNE will make a good-faith effort to arrange for the expedient transfer of all patients to another qualified provider upon termination of the provider’s agreement.
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