If you get ongoing treatment from a provider who is not in the AmeriHealth Caritas Next network, you may be able to keep getting that treatment.
Treatment or services are "ongoing" if you were treated during the past 12 months for a condition that needs follow-up care or additional treatment. Services are also ongoing if they were already approved.
Continued care eligibility
You are allowed to continue ongoing treatment with a health care provider who is not in our network when any of the following happens:
- You are a new AmeriHealth Caritas Next enrollee and you are getting ongoing treatment from a health care provider who is not in the AmeriHealth Caritas Next network.
- You are a current AmeriHealth Caritas Next enrollee and you are getting ongoing treatment from a health care provider whose contract has ended with AmeriHealth Caritas Next for reasons that are "not-for-cause."
Reasons that are "not-for-cause" means the provider's contract did not end because of the quality of the provider’s care or because the provider did not meet other contract or regulatory requirements.
If you have questions, call Enrollee Services at 1-833-613-2262 (TTY 1-844-214-2471).