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Changing Your Primary Care Provider
If, for some reason, you want to change your Primary Care Provider, just call the toll-free number on your card under Member Services and speak with a Representative. He/she will note your request or assist you in identifying a new PCP if necessary. The change will be effective immediately. Within two (2) weeks, you will receive a new Membership Card in the mail with your new PCP's name on it. You may change your PCP up to three (3) times per contract year.
Specialty Services Should your Primary Care Provider determine that you require specialty services, you will get a written referral to a participating Atlantis Health Plan specialist. This form contains authorization for you to be treated, as well as information for the specialist about your condition. After you receive services, the specialist then uses the form to bill Atlantis Health Plan for payment. The referral is valid for up to ninety (90) days as long as you are an Atlantis Health Plan Member, and can only be used for the service indicated on the form. Should you need additional treatment or tests, another referral form must be obtained from your PCP. In this way, your Primary Care Provider can assure that you are always receiving the most appropriate, medically necessary care, and you will be covered one hundred percent (100%) for the referred services you receive, after payment of the applicable copayment. Specialist as Primary Care Physician (PCP).
As a new Member upon enrollment, or a current Member upon diagnosis with a life-threatening condition or disease or a degenerative and disabling condition or disease, either of which requires specialized care over a prolonged period of time, you may request to elect an Atlantis Health Plan Specialist as your PCP. As the designated Specialist/PCP, he/she will be responsible for providing and coordinating all of your primary and specialty care. The Specialist will be able to order tests, arrange procedures and provide referrals and medical services in the same capacity as a PCP. To become a Specialist/PCP, he/she must have the necessary qualifications and expertise to treat your condition or disease. This election will be permitted only if the Atlantis Health Plan Medical Director, after consulting with both your Specialist and your original PCP, agrees that your care would most appropriately be coordinated in this manner.
You, the Specialist, and/or your original PCP may call the Atlantis Utilization Management Department and request this election.