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Atlantis Health Plan Member Handbook- POS

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TRANSITIONAL CARE

If a member's health care provider leaves the Plan's network for reasons unrelated to quality of patient care, question of imminent harm to patients, fraud, or disciplinary action, the Plan will allow the Member to continue an ongoing course of treatment with the provider for a transition period of up to 90 days from the date of notice to the member of the provider's disaffiliation from the AHP 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.

The Plan will allow a new member to continue an ongoing course of treatment with an existing provider if the Member has 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 Member who has entered the second trimester of pregnancy 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 AHP’s reimbursement rates as payment in full; (2) to adhere to AHP's quality assurance requirements and to provide the necessary medical information related to such care; and (3) to otherwise adhere to AHP policies and procedures including, but not limited to procedures regarding referrals and obtaining pre-authorization and a treatment plan approved by AHP.

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