The Alliance is committed to ensuring that our eligible members receive medically necessary services without interruption.

We have a continuity of care process for providers not contracted with the Alliance (also known as out-of-network). New Alliance members may continue to see their non-contracted physicians and utilize specific medical services, for up to 12 months for their medical services after enrollment, as long as the following Continuity of Care guidelines are met. If your providers do not join the Alliance network by the end of 12 months, you will need to switch to providers in the Alliance network.

If your provider stops working with the Alliance, you may be able to keep getting services from that provider. This is another form of continuity of care.

ALLIANCE MEDI-CAL MEMBERS

Alliance Medi-Cal members may continue seeing a non-Alliance provider or specialist if the plan decides that:

  • The treatment with the non-Alliance provider is medically appropriate; and
  • You or the non-Alliance provider give us proof that you received care from your provider in the last 12 months before enrolling with the Alliance; and
  • The non-Alliance provider is willing to accept the same payment rate as similar Alliance providers for Medi-Cal services.

The Alliance provides continuity of care services for:

  • Acute Condition – Completion of covered services shall be provided as long as the acute condition lasts.
  • Newborn Care – The care of a newborn child between birth and age 36 months. Covered services shall be completed within 12 months from your provider’s contract termination date.
  • Pregnancy (including postpartum care) – Completion of covered services shall be for the duration of the pregnancy.
  • Serious Chronic Condition – Completion of covered service shall be for a period of time needed to complete a course of treatment, and to arrange for a safe transfer to another provider. This will be done when the Alliance consults with the member and the non-Alliance provider. Completion of covered services shall not exceed 12 months from your provider’s contract termination date.
  • Surgeries or Procedures – Surgeries and/or procedures that the Alliance had authorized as part of a documented course of treatment. This must have been recommended and documented by the non-Alliance provider to occur within 180 days of the end of the provider’s contract.
  • Terminal Illness – Completion of covered services shall be for the duration of the terminal illness. Covered services may exceed 12 months from the time the end of your provider’s contract with the Alliance.

To learn more or request continuity of care, please call:

To learn more about your benefits and covered services, please view your Alliance Medi-Cal Member Handbook.