Written by a parent, not a doctor. Nothing here is medical advice.

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Texas program

Keep your oncologist if the network changes (Texas insured plans)

If your cancer team leaves the network, Texas rules can let you keep seeing them temporarily at in-network prices.

What it is

If your cancer team leaves the network, Texas rules can let you keep seeing them temporarily at in-network prices.

A network change does not always mean changing oncologists immediately. Texas continuity rules can preserve in-network terms for a limited period. The plan and care team must confirm the arrangement and its end date.

Who this can help
  • Texas HMO and PPO continuity provisions address special circumstances, including a life-threatening condition or disability, terminal illness and pregnancy beyond 24 weeks.
  • Private self-funded plans use federal protections and their own transition rules. Medicaid plans use a separate route.
  • The Texas duty clauses do not name teacher and state-employee plans. The administrator confirms the plan’s own transition-of-care policy.
What you get
  • Up to 90 days with a departing doctor or hospital at in-network cost-sharing.
  • A longer period of up to nine months for a qualifying terminal illness.
What the rules cover
  • Insurance Code 843.362 and 1301.154 provide the Texas continuity routes. The clinician’s letter supports the appropriate period and category.
  • Texas surprise-billing protections and the chapter 1467 dispute process are separate protections for applicable state-regulated coverage.
If you decide to apply
  1. Give the plan’s network-change notice and treatment schedule to your social worker.
  2. Ask the oncologist for a letter explaining why interrupting care would harm your child.
  3. Ask the social worker to help send a written continuity request before the network contract ends.

TDI: 800-252-3439; Medicaid plan concerns: 866-566-8989 · Official page ↗

What happens next
  • Written approval should identify the doctor or hospital, covered dates and in-network payment terms.
  • The social worker can help check the next care arrangement before the approved period ends. A denied request can go to TDI when the plan falls within its authority.
Good to know

This is temporary protection, not permanent network access. The doctor or hospital must accept the continuity arrangement.

Other details
  • The nine-month period requires a qualifying terminal-illness finding. A cancer diagnosis alone does not establish that category.
Official sources
Ask your social worker

“If our oncologist or hospital leaves the network, can you help us request continued in-network care and understand how long it would last?”

Why I’m asking: I want a network change to cause as little disruption to treatment as possible.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

The day you hear a provider is leaving, ask the plan in writing for continuity of care with the treatment schedule.

Your social worker

Confirms the physician and hospital will accept continuity terms and helps draft the request.

The care team

Writes that interrupting treatment would harm the child and names the requested period.

Who decides
The health plan grants continuity. TDI enforces on complaint
Ask your social worker
“Our oncologist is leaving the network. Can you help send the continuity-of-care request before the termination date?”

How to apply

First step: The day you hear a provider is leaving the network, ask the plan for continuity of care in writing, with the treatment schedule.

  1. The day you hear a provider is leaving the network, ask the plan for continuity of care in writing, with the treatment schedule.

Where it starts: Written continuity request to the plan before the termination date

What to gather

  • The plan's termination notice
  • The oncologist's letter and treatment schedule
  • The provider-contract end date

How long: Ask before the termination date. The plan must give reasonable advance notice.

What a yes looks like

Written confirmation of in-network terms with the departing provider for the period requested.

What a no looks like, and the next move

Call TDI at 800-252-3439. For Medicaid managed care, use 866-566-8989 instead.

Watch out

  • Send the continuity request in writing before the termination date, with the oncologist's letter.
  • Self-funded plans, and the teacher and state-employee plans the Texas sections do not name, follow the federal No Surprises Act and their own transition rules. Ask HR or the plan.
  • Do not claim “terminal” to reach nine months. The oncologist's letter decides the category.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 8, 2026.

What it is worth

Up to 90 days of continued in-network coverage with a departing oncologist or hospital for a child with a life-threatening condition (nine months if terminal). Surprise-billing protection on state-regulated plans.

Legal protection: 90-day continuity at in-network cost sharing for a special circumstance · Nine months for terminal illness · Surprise-billing dispute process on state-regulated coverage (ch. 1467)

What it costs the family: In-network cost sharing continues.

The eligibility facts, as published

Plan
state-regulated HMO or PPO
Circumstance
life-threatening condition or disability; terminal illness; pregnancy past 24 weeks
Public employee plans
1301.154 and 843.362 are duty clauses on insurers and HMOs, not plan lists; the teacher and state-employee plans are not named; ask the plan for its transition-of-care policy

The trap: Send the continuity request in writing before the termination date, with the oncologist's letter.

Where I read this

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