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My HMO is dropping my doctor while I am still in treatment. Can I keep seeing them at the plan rate?

Health insuranceWho paysTexasChecked Nov 6, 2026

From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: Texas Insurance Code · Chapter 843 · § 843.362(a) (Continuity of Care; Obligation of Health Maintenance Organization) View original ↗

In short

  1. Texas lets some HMO patients keep treatment with a leaving doctor [2].
  2. It applies when stopping care could harm you, which your doctor must say [1] [3].
  3. The usual limit is 90 days, and two cases run longer [4] [5].

What this means

Texas has a rule for this, and it turns on two words: special circumstance. That means a condition where your treating doctor reasonably believes that stopping that care could cause you harm [1]. The law gives examples. A disability. An acute condition. A life-threatening illness. Being past the 24th week of pregnancy [1].

When that is true, the contract must keep the plan on the hook. Every contract between an HMO and a doctor must cover what happens when the contract ends [2]. Ending it does not release the plan from paying a doctor who is giving medically necessary treatment at that time to an enrollee with a special circumstance [2]. There is a carve-out: it does not hold if the contract ended for reason of medical competence or professional behavior [2]. The plan must keep paying at not less than the contract rate while you keep getting that treatment [2].

Your doctor has to start it. The treating doctor identifies the special circumstance [3]. The doctor must request that you be allowed to continue treatment under their care [3]. And the doctor must agree not to seek payment from you of any amount you would not owe if the doctor were still in the plan network [3].

The window ends. This duty does not run past the 90th day after the end date [4]. Were you diagnosed with a terminal illness at that time? Then the limit is nine months [4]. One case runs longer. Past the 24th week of pregnancy, the duty runs through delivery [5]. It applies to care right after birth [5]. And it covers a checkup within six weeks after delivery [5]. These sections are the HMO chapter. So a preferred provider plan, or a plan that pays its own claims at work, runs on other rules.

Your next step

Ask your doctor to identify the special circumstance in writing, and to request that you keep treatment under their care [3]. Ask for the second promise in the same letter: no bill to you above your in-plan share [3]. Send a copy to the plan and ask it to confirm two things in writing: the rate it will pay, and the end date it will use [2] [4]. The clock in the law is short. The plan's duty does not run past the 90th day after the termination date [4]. Were you diagnosed with a terminal illness at that time? Then that limit is nine months instead [4].

Check it yourself

Find the end date in the notice your plan sent, then count 90 days from it [4]. Read the part of your coverage papers on continuity or transition of care next to that date. Is your own condition a special circumstance? "Don't know yet" here, because your treating doctor decides that first [1][3].

Where this comes from (5)

  1. [1] Texas Insurance Code · Chapter 843 · § 843.362(a) (Continuity of Care; Obligation of Health Maintenance Organization) · checked 2026-11-06

    In this section, “special circumstance” means a condition regarding which a treating physician or provider reasonably believes that discontinuing care by that physician or provider could cause harm to an enrollee who is a patient. Examples of an enrollee who has a special circumstance include an enrollee with a disability, acute condition, life-threatening illness, or who is past the 24th week of pregnancy.

  2. [2] Texas Insurance Code · Chapter 843 · § 843.362(b) (Continuity of Care; Obligation of Health Maintenance Organization) · checked 2026-11-06

    Each contract between a health maintenance organization and a physician and provider must provide that termination of the contract, except for reason of medical competence or professional behavior, does not release the health maintenance organization from the obligation of continuing to reimburse a physician or provider providing medically necessary treatment at the time of termination to an enrollee who has a specia…

  3. [3] Texas Insurance Code · Chapter 843 · § 843.362(c) (Continuity of Care; Obligation of Health Maintenance Organization) · checked 2026-11-06

    The treating physician or provider shall identify a special circumstance. The treating physician or provider must: (1) request that an enrollee be permitted to continue treatment under the physician's or provider's care; and (2) agree not to seek payment from the enrollee of any amount for which the enrollee would not be responsible if the physician or provider continued to be included in the health maintenance organ…

  4. [4] Texas Insurance Code · Chapter 843 · § 843.362(d) (Continuity of Care; Obligation of Health Maintenance Organization) · checked 2026-11-06

    this section does not extend the obligation of a health maintenance organization to reimburse a terminated physician or provider for ongoing treatment of an enrollee after: (1) the 90th day after the effective date of the termination; or (2) if the enrollee has been diagnosed with a terminal illness at the time of termination, the expiration of the nine-month period after the effective date of the termination.

  5. [5] Texas Insurance Code · Chapter 843 · § 843.362(e) (Continuity of Care; Obligation of Health Maintenance Organization) · checked 2026-11-06

    If an enrollee is past the 24th week of pregnancy at the time of termination, a health maintenance organization's obligation to reimburse a terminated physician or provider or, if applicable, an enrollee extends through delivery of the child and applies to immediate postpartum care and a follow-up checkup within the six-week period after delivery.

How we found this

We matched your question to 5 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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