What are transitional benefits?
If a person is currently seeking care or undergoing a course of treatment from an out-of-network provider at the time coverage goes into effect, that person may request ongoing care with that provider for a period of time. To continue receiving the highest level of benefits, a Transitional Care Request form must be completed and approved. The form is available from the Web site. The form may be mailed or faxed; instructions for submitting the request are on the form.
IMPORTANT - If you are already seeing a network provider, you do NOT need to complete the Transitional Care Request form.
All requests are subject to approval.
If the transitional care request is approved, the person may continue to see their out-of-network provider and receive the in-network level of benefits. However, the patient may be billed for charges exceeding the Blue Cross and Blue Shield of Texas allowable amount.
If the transitional care request is denied, the person may still continue to see their out-of-network provider, but benefits will be paid at the out-of-network level.