If your health care provider leaves the Atlantis Health Plan Network for reasons unrelated to quality of patient care, question of imminent harm to patients, fraud, or disciplinary action, Atlantis Health Plan will allow you to continue an ongoing course of treatment with the provider for a transition period of up to ninety (90) days from the date of notice to you, of the provider's disaffiliation from the Atlantis Health Plan network. In the case of a pregnancy that has entered the second trimester at the time of the provider's disaffiliation, the transitional period will include the provision of post-partum care directly related to the delivery.
Atlantis Health Plan will allow a new Member to continue an ongoing course of treatment with an existing provider if you have a life-threatening condition or disease or degenerative and disabling condition or disease for a transitional period of up to sixty (60) days from the effective date of enrollment. In the case of a pregnancy that has entered the second trimester at the time of enrollment, the transitional period will include the provision of post-partum care directly related to the delivery.
Transitional care will only be authorized if the health care provider agrees (1) to accept Atlantis Health Plan's reimbursement rates as payment in full; (2) to adhere to Atlantis Health Plan's quality assurance requirements and to provide the necessary medical information related to such care; and (3) to otherwise adhere to Atlantis Health Plan policies and procedures including, but not limited to procedures regarding referrals and obtaining pre-authorization and a treatment plan approved by Atlantis Health Plan.
Pre-authorization is necessary for any hospital admissions and/or outpatient surgery you may need, unless you are admitted on an emergency basis. If you need elective hospital services, you will be admitted to the hospital where your Primary Care Provider or referred specialist is affiliated. All non-emergency hospital admissions must be pre-authorized by Atlantis Health Plan and your Primary Care Provider. The participating provider will contact Atlantis for pre-authorization. All appropriately referred and pre-authorized hospital services are covered one hundred percent (100%), after payment of the required copayment.
If you are admitted to a non-participating hospital because of an emergency, you may be transferred, at no additional cost to you, to an Atlantis Health Plan participating hospital when you are well enough, so that your Atlantis Health Plan doctor can treat you.