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Humana continuity of care form

Humana request for continuity of care form 2026

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The document is a Humana Request for Continuity of Care Form, which allows members to request continued treatment from their physician while maintaining in-network benefits for specific medical conditions. It outlines the process for submitting the form within 30 days and provides examples of qualifying situations, such as ongoing treatments and chronic conditions. The form requires member information and details about the treating physician.

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Click ‘Get Form’ to open the Humana Request for Continuity of Care form in our platform.
Begin by checking any applicable situations that may qualify you for continuity of care, such as ongoing medical treatments or specific chronic conditions.
Fill in your Member Information, including your first name, middle initial, last name, and Member ID number. Ensure all details are accurate.
Provide the Patient Name and Subscriber Name along with your complete address, city, state, and zip code.
Enter your home and work phone numbers, as well as your birthdate in the specified format (MM/DD/YY).
Select the type of plan you have by checking either HMO, PPO, or POS.
Lastly, include the name and phone number of your treating physician before submitting the form.

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2007	4.9 Satisfied (52 Votes)

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humana continuity of care

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