What If My Health Insurance Changes During my Accident Claim?

In the state of Utah, everyone involved in an auto accident can access Personal Injury Protection (PIP) insurance regardless of fault. However, once your PIP limit is exceeded, you may have to front the cost of your medical treatment with your own health insurance; receiving compensation once your claim has been settled. But what happens if your health insurance plan changes halfway through medical treatment? 

If you need to change your health insurance provider, you can request a ‘transition of care’ or a ‘continuity of care’ with your new insurance company. If this request is granted, your new health insurance will continue to cover the costs of your medical treatment as your old provider would have. However, as every insurance provider and policy differ, you should contact your new health insurance provider to discuss your options.

Request a Transition of Care

If you apply for a transition of care, you must do so before you change health insurance providers. However, a transition of care will only apply to patients who have a diagnosed condition, with a defined number of treatments or treatment period.

If your transition of care request is accepted, you will be able to continue receiving treatment from the provider that initiated your treatment. Your new insurance company should treat your provider as if they are covered by your new network. However, for a better chance of approval, you must be involved in an ‘active course of treatment’; initiated prior to enrolling in a new health insurance plan. 

How to Apply For a Transition of Care

To apply for a transition of care, you will need to fill out a request form through your insurance. Once your insurance reviews your application, you will receive a letter declaring their acceptance or rejection of your request; upon approval, your transition of care coverage will only last until your treatment is completed. 

When applying for a transition of care, your insurance may require your medical provider to sign the request form. It may take upwards of 15+ days to receive approval for a transition of care; plan accordingly and submit an application as soon as possible.

Transition of Care v.s. Continuity of Care

 A transition of care applies in circumstances where you are changing health insurance providers; where your new provider may not cover your current doctor whom you are already receiving treatment from. Coverage for a transition of care will end when an in-network provider can safely take over your care.

Conversely, through continuity of care, you can continue to receive coverage for treatment provided by a medical professional that has left your health insurance’s network. In order to qualify for this program, you must provide clinical reasons why you cannot receive care from an in-network provider. You must also submit your request for continuity of care within 30 days of your medical provider leaving the network.

What Conditions May Qualify You For These Programs?

  • Hospital confinement
  • Recent major surgeries (which require follow-up appointments) 
  • Organ transplant complications
  • Trauma
  • Cancer
  • Diabetes
  • Asthma
  • Allergies

**This is not an exhaustive list

How a Utah Car Accident Attorney Can Help You

If you have been involved in an auto accident and are currently seeking treatment for your injuries, a Utah car accident attorney can assist you. If you hire an attorney, they can enter into lien agreements with your medical providers; helping you receive the treatment you need without having to front the cost using your own health insurance. Instead, your medical providers will receive compensation after your insurance claim settles.

Were you or someone you know involved in a recent auto accident? Call Auto Accident Care Network now at 801-683-1948 to connect with a live care advocate. Our team at AACN can connect you to trusted attorneys and doctors to schedule a free legal consultation, a free thirty-minute massage, and a no-cost medical exam!