Continuing or Transitioning Care
Continuity of care
We want to make it easy for you to get the care you need. But finding the right provider can be hard if you have a special health concern. That’s why we help members with specific conditions when they need to find a new provider. Most often, you’ll need to deal with continuity of care if:
- Your employer changes from another health plan to HealthPartners because you must use HealthPartners network providers to get the best benefits available. And, depending upon your benefits, prescription drugs may only be covered if they are on the HealthPartners Preferred Drug Lists (Formularies), our lists of covered drugs. However, we may make an exception if you have special health needs.
- Your primary clinic, specialty clinic or hospital ends its participation in a HealthPartners network, in which case we will notify you in writing at least 30 days before the contract ends (if we are given adequate notice). The letter will tell you the date the provider is no longer available, other care options available to you after the contract ends and how to transfer care to a new provider.
Considerations for those with special health needs
When a provider leaves our network or an employer changes health plans, we work to make the change to a new provider smooth and hassle-free. You may call us to request a short period of continuation of services from a provider who does not participate in your HealthPartners network if you are a:
- Female member in your second or third trimester of pregnancy
- Member who has an acute condition or illness
- Member who has a mental or physical disability that prevents you from doing major life activities
- Member who has a life-threatening mental or physical illness
- Member who has special cultural and/or language needs
In addition, members who have a short life expectancy due to a terminal illness may request to continue seeing their current provider until the end of their life.
We evaluate each request on a case-by-case basis using the following factors:
- The reason for the request
- The length of time and/or scope of services involved in the request
- Whether a smooth transition can be made before the HealthPartners plan becomes effective or the provider contract ends
- The overall impact on the member’s physical and psychological health
- The availability of HealthPartners network providers who can provide necessary services
Are you a new HealthPartners member because your employer changed health plans? If so, you’ll want to check your contract or call HealthPartners Member Services to find out what kind of pharmacy benefit you have. Some HealthPartners plans require members to use only those drugs that are on our preferred drug lists. You can view our preferred drug lists to learn if your prescription drug is covered at the highest level.
If your drug is not on the preferred drug lists, talk to your doctor about alternative medications. If your doctor believes you should continue using your current drug, he or she can request coverage for a non-preferred drug. The review process is quick, usually taking only an hour or two. A HealthPartners medical reviewer will consider information provided by your doctor, including:
- The kind of drug you’re taking
- The nature of your condition or illness
- How long you’ve been taking the drug
- How well it’s working for you
If the non-preferred drug is approved for coverage, we will flag our pharmacy system so that you won’t need to get approval each time you refill your prescription.
Where to go for help
Each request is evaluated on a case-by-case basis using the factors listed above. If you need help, please call Member Services.