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Atlantis Health Plan Member Handbook- POS

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Experimental and investigational therapies or procedures are health care modalities, which are undergoing evaluation in clinical trials to determine the effect on a disease or injury. Depending upon the period during the evaluation, the experimental and investigational therapies or procedure may or may not have been deemed safe and/or effective by the Food and Drug Administration (FDA) or National Institutes of Health (NIH).

Upon written request, AHP will evaluate the experimental and investigational therapy or procedure for authorization for use. If a more conventional treatment or procedure is available, and is similarly effective and appropriate, AHP may not authorize the experimental or investigational treatment or procedure. The determination for approval will be based upon medical necessity, safety, effectiveness and whether or not the procedure or treatment has received approval by the FDA or NIH. Lack of approval by FDA or NIH will not prevent it being authorized if the procedure or treatment is the only medically appropriate alternative available.


As a member of Atlantis Health Plan, you are entitled to obtain complete current information concerning a diagnosis, treatment and prognosis from a physician or other provider in terms and language that can be reasonably understood by you. When it is not advisable to give such information to you, the information will be made available to an appropriate person on your behalf. In addition you are entitled to receive information from a physician or other provider necessary to give informed consent prior to the start of any procedure or treatment. Lastly, you have the right to refuse treatment to the extent permitted by law and to be informed of the medical consequences of the action.

Advance Directives: You have the right to participate in decisions relating to your health care. Working with your doctor, you can decide whether to accept or reject proposed medical treatments. That right extends to situations where, because of your medical condition, you are unable to communicate with your doctor or the hospital. This is done by the creation of an Advance Directive.

An Advance Directive is a written, signed document, that provides instructions for your care if you are unable to communicate your wishes directly. Depending on the state where you are receiving treatment, the most common forms of Advanced Directives are Living Wills and Durable Powers of Attorney. These documents instruct your health care providers how to proceed if you are not able to communicate with them.

Additionally, The New York State Health Care Proxy Law allows an adult to designate another adult, such as a trusted friend or loved one who knows the person and his or her wishes, to make these treatment decisions if the adult becomes incapacitated and is unable to do so.

You are not required to have an Advance Directive or proxy, however, if you are interested in obtaining further information or receiving the appropriate forms please call or write the AHP Member Services Department.

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