SAMPLE Letter
to health Plan from Patient Requesting Continuity of Care

Dear [PLAN ADMINISTRATOR]:

Every health plan is required to file with the [Department of Managed Health Care] [Department of Insurance], a written policy describing how the health plan will facilitate the continuity of care for new enrollees receiving services during a current episode of care for an acute condition or an acute, serious, or chronic mental health condition from a nonparticipating provider. (Health & Safety Code §1373.5; Insurance Code §10133.55.) [For nonmental health conditions the written policy must describe the process used to facilitate the continuity of care, including the assumption of care by a participating provider.] [For mental health conditions: This written policy must allow me a reasonable transition period to continue my treatment from [name of physician] prior to transferring to another mental health provider and must describe how continuity of care is assured, including the provision of timely, appropriate medically necessary services.]

Please continue my care with [name of physician], who is currently treating my [name of illness or condition], a condition covered under these laws.

Thank you for your anticipated cooperation with this request. Unless I hear from you to the contrary, I will continue to see [name of physician].

Sincerely,

_______________________
(Patient’s signature)

cc: [name of physician]