If a member is seeing a provider who is not part of our network, our continuity of care policy may be able to cover some of his or her health services, including behavioral health (mental health and/or substance use disorder) services.
A member may be able to keep seeing the out-of-network provider in the following situations:
- The provider is caring for a pregnancy and the member is in the second or third trimester of pregnancy, and the provider leaves the Tufts Health RITogether plan. The member may be able to keep seeing this provider through delivery.
- The provider is actively treating a chronic or acute medical condition (with a treatment like dialysis, home health services, chemotherapy or radiation). The member may be able to keep seeing the provider for up to 30 calendar days.
- The member is terminally ill or has significant health care needs or a complex medical condition, including serious or persistent mental illness. The member may be able to keep seeing the provider.
- The individual became a Tufts Health RITogether member by changing from another Rhode Island Medicaid plan and has already begun treatment (such as ongoing maternity care) with a provider who does not contract with us. We will review that treatment and may approve the continued treatment by the same provider.
After the period of continuity of care ends, the member can continue to get care or treatment by choosing a Tufts Health RITogether in-network provider.