Continuity of Care

General
Policy Number: GP-X-013

Last Updated: May 24, 2022 

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 responsible to continue 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 post-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 6 weeks post delivery date (after first trimester)
High-risk pregnancy Up to 90 days post 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 post-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.

When BCBSNE becomes aware of one of these situations, we will send a Continuity of Care form to the member. To continue to receive in-network benefits for the conditions/time frames listed above, the form must be completed and returned to us.
  
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.