Continuity of Care Service Requests - (HM-CLN-038)

Cigna authorizes continuity/transition of behavioral health care for members in active treatment or special circumstances (pregnancy, life‑threatening/terminal illness, serious acute/chronic conditions, cultural/language needs, inpatient care, and No Surprises Act 90‑day requests) when a provider leaves the network, except where plan benefits exclude services or the provider was terminated for cause (misconduct, incompetence, fraud) or no longer practices in the service area. Requests generally must be submitted within 90 days of notice (state‑specific windows and duration limits apply, common default = 90 days), coverage is time‑limited, and approvals require documentation (case notes, 12‑month claims/encounter history, customer notification), provider agreement to prior reimbursement/quality requirements where applicable, and Medical Director review for non‑routine exceptions.

"Continuation of care when any participating provider or facility leaves the network and ongoing care is requested."