If you now see providers who are not in the L.A. Care network, in certain cases you may be able to keep seeing them for up to 12 months. If your providers do not join the L.A. Care network by the end of 12 months, you will need to switch to providers in the L.A. Care network. You can continue to see your providers when:
- L.A. Care determines you have an existing relationship with your out-of-network provider. An existing relationship means you saw the out-of-network PCP or specialist at least once during the 12 months prior to the date of your initial enrollment with L.A. Care for a non-emergency visit.
- Your out-of-network provider is willing to accept the higher of L.A. Care's contract rates or Medi-Cal FFS rates.
- Your out-of-network provider meets L.A. Care's applicable professional standards and has no disqualifying quality-of-care issues.
- Your out-of-network provider is a California State Plan approved provider; and
- The provider supplies L.A. Care with relevant treatment information.
Members, their authorized representatives, or providers may make a direct continuity of care request to L.A. Care in writing or by telephone.