Continuity of care

You can continue to see a provider who leaves your network

It can cost much more to see out-of-network doctors rather than those that participate in your network. New York and federal laws provide an important benefit if your provider leaves your network or no longer accepts your insurance.

You can continue seeing, at the same cost, a provider who leaves your network for 90 days or until the end of postpartum care. This includes hospitals and other facilities, as well as individual providers and practices. 

Here are some details:

If you are receiving an ongoing course of treatment, you have the right to continue receiving services at the same cost sharing amount, for 90 days or through the end of postpartum care. Specifically, you can continue treatment with your provider if you are any of the following:

  • seeing your provider for a serious and complex condition (either acute or chronic), and if the treatment would prevent serious harm
  • undergoing a course of inpatient treatment
  • scheduled for nonelective surgery
  • pregnant and receiving treatment for pregnancy, or receiving postpartum care
  • receiving treatment for a terminal illness

When your provider’s in-network status ends, your health plan must tell you of your right to continue care. Notify your plan if you choose to continue treatment. Notification is not required for all plans, but we recommend that you do this. 

The 90-day care period should run from the date of the provider's termination from the network.

These protections apply to services provided to most individuals who have commercial health insurance, such as:

  • employment based group health plans
  • individual or group health coverage, including coverage bought through the New York State of Health, the official health plan marketplace
  • Federal Employee Health Benefit (FEHB) health plans
  • non-federal government plans sponsored by state and local government employers
  • certain church plans
  • student health insurance coverage

You do not have the same rights to continue treatment for 90 days with the same provider if they were terminated because of quality of care or fraud.