The No Surprises Act includes continuity-of-care protections for certain continuing-care patients when a plan or issuer terminates its contract with a provider or facility. These protections generally apply to many commercial group and individual plans, not to Medicare, Medicaid, TRICARE or VA coverage.
The protection is not a blanket right to keep every out-of-network provider indefinitely. It applies in defined circumstances and for a limited transition period.
- Date the provider/facility leaves network
- Whether the plan identifies you as a continuing-care patient
- Required election or notice
- Transition period end date
- Cost sharing during transition
- Existing authorization status
- Long-term in-network replacement plan
Ask whether you qualify as a continuing-care patient
If you are receiving an ongoing course of treatment and the network relationship changes, ask the plan whether you meet its continuing-care criteria and what notice or election is required.
Do not rely only on the provider saying it is leaving the network. Contact the plan and ask for the continuity process in writing.
Confirm the temporary cost-sharing treatment
When the protection applies, the goal is to let the qualifying patient continue care for the transition period under specified terms rather than abruptly treating every service as ordinary out-of-network care.
Ask how claims will be processed, whether prior authorization stays valid and what patient cost sharing should apply during the transition.
Use the transition period to build the next stable plan
A continuity period is a bridge. During it, identify a long-term in-network provider or facility if the old network relationship will not return.
If the medicine requires a specific infusion site, specialist expertise or rare-disease center, document why the replacement network must be clinically and operationally capable of delivering the treatment.
Use the source that actually controls your case
MedicineCostHelp can organize the problem, but the member-specific plan, Medicare program, provider billing record or assistance program makes the actual decision. Save written determinations and reference numbers so the next person does not have to reconstruct the case from scratch.