If you now see doctors who are not in the HPSJ group, in certain cases you may be able to keep seeing them for up to 12 months. If your doctors do not join the HPSJ group by the end of 12 months, you will need to switch to doctors in the HPSJ group. You can still see your doctors when:
- HPSJ determines you have an existing relationship with your out-of-network doctor. An existing relationship means you saw the out-of-network PCP or specialist at least once during the 12 months before the date of your initial enrollment with HPSJ for a non-emergency visit.
- Your out-of-network doctor is willing to agree the higher of HPSJ’s contract rates or Medi-Cal FFS rates.
- Your out-of-network doctor meets HPSJ’s applicable professional standards and has no disqualifying quality-of-care issues.
- Your out-of-network doctor is a California State Plan approved doctor; and
- The doctor supplies HPSJ with relevant care facts.
Members, their approved representatives, or doctors may make a direct continuity of care ask to HPSJ in writing or by phone. At any time, a member may change doctors to a doctor who is a member of an HPSJ network. To ask for Continuity of Care please call HPSJ at 209-942-6352