Wisconsin program
Keeping a doctor during a network change (continuity of care)
Wisconsin rules can preserve access to a doctor for a limited period during a network change.
What it is
Wisconsin rules can preserve access to a doctor for a limited period during a network change.
If your child's doctor leaves the plan's network mid-treatment, the plan must let the current course continue for up to 90 days. The exact doctor, treatment and plan type decide it.
Eligibility rules
- The Wisconsin rule applies to managed care plans. The primary-care protection concerns the doctor listed at enrollment; specialist protection concerns the current course of treatment.
What you get
- A limited period of continued access to an eligible specialist.
- Protection for the primary doctor listed at enrollment for the plan year, subject to the rule's terms.
If you decide to apply
- Ask the plan in writing for continuity of care, naming the doctor and current treatment course.
- Ask the oncology team to describe the course and expected duration for the plan's review.
Your insurer and oncology team; Wisconsin insurance regulator: 800-236-8517 · Official page ↗
Good to know
The specialist period can end before 90 days if the current treatment course ends sooner. Exceptions can change the result.
Other details
- The plan's ordinary in-network cost sharing applies while the protection lasts. Written confirmation can identify the approved doctor and end date.
- The doctor must have been listed as in-network when you enrolled and then left. A specialist can be kept for the current course of treatment or 90 days, whichever ends first; the primary doctor can be kept to the end of the plan year. A federal rule can give another 90 days, including on a self-funded plan.
- Under the Wisconsin rule, qualifying primary-care continuity lasts to the end of the plan year. Pregnancy has separate provisions. Your plan confirms which rule applies to your doctor and treatment.
Official sources
“If our child's doctor leaves the network, could continuity of care help, what are its limits, and could you help us request it if needed?”
Why I’m asking: I want to understand how long treatment with the current doctor could continue and what comes next.
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
Ask in writing, naming the doctor and the course of treatment.
Your social worker
The oncology team writes what the current course of treatment is and how long it runs.
The care team
Records and letters when the application asks for them.
- Who decides
- The plan.
- Ask your social worker
- “Our oncologist is leaving the network. Can the team write down the current course of treatment so we can ask the plan for continuity of care?”
How to apply
First step: Write to the plan the day you hear a doctor is leaving, ask for continuity of care, and name the treatment course.
- Ask the plan in writing for continuity of care the day you hear a doctor is leaving the network.
- Ask the oncology team to describe the current course of treatment and how long it runs.
Official application / program page ↗
Where it starts: Ask the plan in writing for continuity of care by name, saying which doctor and which course of treatment.
What to gather
- The plan's network notice
- The oncology team's description of the current course
- The doctor's name and speciality
How long: Wisconsin’s rule depends on the provider having been represented as participating at the relevant enrollment or renewal and then leaving the network. Primary-care, active specialist treatment and later-pregnancy cases have different periods; specialist protection is the shorter of the current course or 90 days and does not extend past the plan year. Provider misconduct and leaving the plan’s geographic service area are exceptions. A separate federal continuing-care rule can provide up to 90 days from notice for a qualifying continuing-care patient, including on a self-funded plan, so the state limit is not always the final answer.
What a yes looks like
Written confirmation that the doctor stays in network for a named period.
What a no looks like, and the next move
The plan says an exception applies. Ask which, in writing, and appeal.
Watch out
- The 90 days can be shortened to the length of the current course of treatment.
- Exceptions apply, so ask the plan in writing which rule it is using.
- Whether public-employer plans follow this was not established.
The numbers and the rules
The arcane layer, kept on purpose. Checked September 11, 2026.
What it is worth
Wisconsin continuity depends on a doctor represented as participating at enrollment or renewal subsequently leaving the network. Qualifying primary care can continue to plan-year end; active specialist care lasts the shorter of the course or 90 days, not beyond plan-year end. Exceptions apply, and federal continuing-care protection may be stronger.
- $90 — Days a specialist can be kept after leaving the network, or the shorter current course of treatment
Legal protection: The primary doctor listed at enrolment, for the plan year · A specialist for 90 days or the shorter current course of treatment
What it costs the family: The plan's ordinary in-network cost sharing while it lasts.
The eligibility facts, as published
- Plans
- Wisconsin managed care plans; applicability to public-employer plans was not established
- Primary
- the doctor listed at enrolment, for the plan year
- Specialist
- Wisconsin’s rule depends on the provider having been represented as participating at the relevant enrollment or renewal and then leaving the network. Primary-care, active specialist treatment and later-pregnancy cases have different periods; specialist protection is the shorter of the current course or 90 days and does not extend past the plan year. Provider misconduct and leaving the plan’s geographic service area are exceptions. A separate federal continuing-care rule can provide up to 90 days from notice for a qualifying continuing-care patient, including on a self-funded plan, so the state limit is not always the final answer.
The trap: This is not an unconditional rule for every doctor who leaves: the guidance lists exceptions, and the 90 days can be shortened to the length of the current course of treatment. Ask the plan in writing what it is applying.
Where I read this
- OCI: Managed Care guide (PI-044) — Wisconsin Office of the Commissioner of Insurance, read September 10, 2026