Understanding Continuity of Care (CoC) at Sidecar Health
Starting a new health plan can be confusing, especially when you're in the middle of an ongoing medical treatment. Continuity of Care (CoC) is a program offered by Sidecar Health to qualifying members to help ease this transition and protect you from unexpected medical bills.
Qualifying members can expect:
- Balance billing protection: It helps prevent you from being responsible for more than the amount your plan covers for your ongoing treatment.
- Peace of mind: It allows you to continue your treatment without worrying about additional out-of-pocket costs other than your deductible.
Qualification criteria
You qualify for Continuity of Care (CoC) for your current medical condition at Sidecar Health if:
- You have an active course of treatment/ current condition related to one or more of the following:
- institutional or inpatient care
- surgery, including receipt of postoperative care concerning such surgery
- serious disease or condition requiring complex ongoing care such as chemotherapy, radiation therapy, or post-operative visits related to the same
- disease or condition for which the treating physician or health care provider attests that discontinuing care by that physician or health care provider would worsen the condition or interfere with anticipated outcomes
- a condition for which the member’s treating physician attests a life expectancy of 6 months or less
- pregnancy in the second or third trimester through eight weeks postpartum
- mental health services provided by a licensed mental health professional whom the member has seen at least once a month for at least six consecutive months prior to their Sidecar Health coverage effective date
AND
2. You have a doctor's appointment scheduled within 30 days of your Sidecar Health coverage effective date, related to your current condition OR you already had an appointment related to your current condition within 30 days of your Sidecar Health coverage effective date.
AND
3. You requested CoC coverage, or Sidecar Health thinks CoC is appropriate for your situation.
How to request CoC:
- Reach out: Contact Sidecar Health Member Care if you believe you qualify for CoC. They will let you know if you might qualify and should proceed with submitting your medical records.
- Submit required documentation: You will need to provide complete visit notes from your last 3 physician encounters among a list of other medical documents related to your ongoing treatment. View full list of requirements.
- Sidecar Health conducts review: Sidecar Health will review your request and let you know if you qualify for CoC .
What happens if my request for CoC is approved?
- You will receive a CoC authorization letter outlining the scope and duration of your coverage.
- Note: CoC will typically last for the duration of the treatment or 90 days, whichever happens first.
- Sidecar Health will handle claims related to your active course of treatment with no additional out-of-pocket costs for you, once you’ve met your deductible, within the authorized scope.
- Remember, CoC does not affect your deductible or other cost-sharing responsibilities.
What is covered under CoC?
- Services related to your active course of treatment, as defined above. Meaning, the ongoing treatment you're already receiving.
- Covered services as listed in your Sidecar Health plan documents, within service limits.
- Services received during the eligibility period, which is usually 90 days from your plan start date, or longer in specific cases like pregnancy or mental health services.
- Maternity coverage: extends up to 8 weeks postpartum.
- Mental health coverage: lasts through the duration of your plan, if you maintain monthly appointments with the mental health professional and their rates remain reasonably consistent with those charged immediately before your Sidecar Health coverage effective date.
What is not covered under CoC?
- Any new treatment you start after your Sidecar Health coverage effective date, even with the same provider.
- Preventive care, like checkups or screenings.
- Routine prescriptions or medical supplies.
What happens if I submit all required documents and my request for CoC is denied?
You will receive a letter explaining why your request was denied and outlining your estimated out-of-pocket costs.
This guide is intended to simplify the information and is not a substitute for your plan documents. If you have further questions about CoC, please contact Sidecar Health Member Care.
