Atlantis Health Plan has attempted to provide its' members with comprehensive benefit packages which provide the basic primary, preventive and specialty care necessary for good health. Covered Services include:
Ambulance Allergy Testing and Treatment Blood and Blood Products Adult Periodic Physical Exams Emergency Room Care Chiropractic Care Hemodialysis Diabetic Equipment and Education Home Health Care Diagnostic X-ray Laboratory Hospice Care DME Prosthetics Medical Supplies Inpatient Care Maternity Care Mental Health Substance Abuse OB/GYN Services Mammography Pap Smears Organ Transplants Second Opinions Pre-Admission Testing Well-Child Care Radiation and Chemotherapy Rehabilitative Services Skilled Nursing Facility Surgical Services
However some medical procedures, services and medical supplies are either specifically excluded from contractual Covered Services or are subject to pre-existing condition exclusion for a specific time period. Further, some Employer Groups may have purchased additional benefit riders to enhance the core benefits package.
Covered services must be medically necessary and appropriate. As such, the Atlantis Health Plan Medical Director may, in the course of the pre-authorization process, either decline to approve a proposed medical procedure or approve an alternative treatment.
Atlantis Health Plan's Member Services Department may be contacted Monday through Friday from 9:00am to 5:00 pm to verify or clarify Covered Services. This verification should be done prior to rendering the service. In contracting with Atlantis, you agreed to accept Atlantis' reimbursement, as stated in the Participating Physician Agreement, as payment in full, less any Subscriber/patient co-payment. Therefore, Atlantis Health Plan members may not be billed any additional amounts for Covered Services.
A member may elect to receive medical care for contractually excluded services or for services determined by Atlantis to be not Medically Necessary. In such instances, you are required to advise the Member prior to providing the service, that the service is not covered, that Atlantis would not assume responsibility for payment, and clearly state the cost the Member must assume. It is highly recommended that a Member sign a waiver accepting liability in such instances.
Covered Services, which require Pre-authorization, may be found in the Pre-authorization and Referral Policies section. The following services are excluded from coverage. If these services are provided, the Member is responsible for payment.