My doctor is leaving my California HMO's network in the middle of my treatment. Can I keep seeing them at the in-network rate?

Health insuranceWho paysCaliforniaChecked Nov 6, 2026

From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: California Legislature · California Health & Safety Code · § 1373.96(a) (Continuity of Care) View original ↗

In short

California lets you keep a leaving doctor for some time [1].
A bad illness or a pregnancy keeps going until it ends [2] [5].
Most other cases stop in 12 months [4].

What this means

California plans must let you finish certain treatments with a doctor who is leaving the network, or already left, if you ask [1]. How long depends on your condition. An acute condition is covered for as long as that condition lasts [2]. A pregnancy is covered for its full term [5]. A terminal illness is covered for as long as it lasts, even past 12 months [6].

Other conditions have a cap. A serious chronic condition is covered long enough to finish treatment and safely transfer you [3], but not more than 12 months after your doctor's contract ended [4]. The same 12-month cap applies to a newborn's care [7]. A surgery or procedure already scheduled is covered if it's due within 180 days of the contract ending [8].

This is a floor, not a ceiling — your plan can offer more than this if it chooses [9].

Your next step

Ask your doctor in writing to name which condition above fits your case. Ask the plan in writing to confirm how long it will keep paying the network rate [1]. The sources give no deadline for the plan to answer.

Check it yourself

Find your doctor's network termination date, then match your condition to the list above and count from that date. This rule is written for an HMO plan. A PPO insurer has its own, similar rule. Whether your plan already offers more than this floor: "Don't know yet" here — check your plan booklet.

Where this comes from (9)

[1] California Legislature · California Health & Safety Code · § 1373.96(a) (Continuity of Care) · checked 2026-11-06
A health care service plan shall, at the request of an enrollee, provide for the completion of covered services as set forth in this section by a terminated provider or by a nonparticipating provider.
[2] California Legislature · California Health & Safety Code · § 1373.96(c)(1) (Acute Condition) · checked 2026-11-06
An acute condition is a medical condition that involves a sudden onset of symptoms due to an illness, injury, or other medical problem that requires prompt medical attention and that has a limited duration. Completion of covered services shall be provided for the duration of the acute condition.
[3] California Legislature · California Health & Safety Code · § 1373.96(c)(2)(A) (Serious Chronic Condition) · checked 2026-11-06
A serious chronic condition is a medical condition due to a disease, illness, or other medical problem or medical disorder that is serious in nature and that persists without full cure or worsens over an extended period of time or requires ongoing treatment to maintain remission or prevent deterioration. Completion of covered services shall be provided for a period of time necessary to complete a course of treatment …
[4] California Legislature · California Health & Safety Code · § 1373.96(c)(2)(B) (Serious Chronic Condition — 12-Month Cap) · checked 2026-11-06
Completion of covered services under subparagraph (A) shall not exceed 12 months from the contract termination date or 12 months from the effective date of coverage for a newly covered enrollee.
[5] California Legislature · California Health & Safety Code · § 1373.96(c)(3)(A) (Pregnancy) · checked 2026-11-06
A pregnancy is the three trimesters of pregnancy and the immediate postpartum period. Completion of covered services shall be provided for the duration of the pregnancy.
[6] California Legislature · California Health & Safety Code · § 1373.96(c)(4) (Terminal Illness) · checked 2026-11-06
A terminal illness is an incurable or irreversible condition that has a high probability of causing death within one year or less. Completion of covered services shall be provided for the duration of a terminal illness, which may exceed 12 months from the contract termination date or 12 months from the effective date of coverage for a new enrollee.
[7] California Legislature · California Health & Safety Code · § 1373.96(c)(5) (Newborn) · checked 2026-11-06
The care of a newborn child between birth and age 36 months. Completion of covered services under this paragraph shall not exceed 12 months from the contract termination date or 12 months from the effective date of coverage for a newly covered enrollee.
[8] California Legislature · California Health & Safety Code · § 1373.96(c)(6) (Scheduled Surgery) · checked 2026-11-06
Performance of a surgery or other procedure that is authorized by the plan as part of a documented course of treatment and has been recommended and documented by the provider to occur within 180 days of the contract's termination date or within 180 days of the effective date of coverage for a newly covered enrollee.
[9] California Legislature · California Health & Safety Code · § 1373.96(k) (Floor, Not a Ceiling) · checked 2026-11-06
The provisions contained in this section are in addition to any other responsibilities of a health care service plan to provide continuity of care pursuant to this chapter. This section does not preclude a plan from providing continuity of care beyond the requirements of this section.

How we found this

We matched your question to 9 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-06.

What we don’t know yet

Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.

Every answer is checked against the official rule it quotes.

Information only — not legal advice. Your plan, insurer or agency decides.

This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.

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