Members who require ongoing care from an in-network specialist may receive a standing referral.
The member's PCP should contact Atlantis Health Plan's Utilization Department to pre-certify the request, which will be reviewed by the Medical Director for appropriateness. If approved, a Standing referral to a specialist will be issued. All parties will be notified verbally and in writing of all final determinations. The referral shall be made pursuant to a treatment plan approved by Atlantis Health Plan in consultation with the PCP, specialist and the member or member's designee. The treatment plan may limit the number of visits or the period during which such visits are authorized and may require the specialist to regularly update the PCP concerning the course of treatment.
Members with Health Plan contracts may not elect to use a non-participating specialist unless there is no equivalent specialist in the Atlantis Health Plan network.
Members will make their own arrangements for appointments at the Primary Care Physician's office and with Specialists, when authorized (except in the instances previously discussed, when women can self-refer to a qualified participating provider of obstetrical and gynecological services).
Providers agree (1) not to differentiate or discriminate in the treatment of his/her members as to the quality of services delivered to members because of race, sex, age, religion, place of residence, handicap, health status or source of payment and (2) to observe, protect and promote the rights of members as members.
Providers agree to provide timely care in compliance with Atlantis Health Plan policies and procedures, which are consistent with the Federal Americans with Disabilities Act. The specific time frames for care are listed below:
PCP/Specialty (other than Mental Health)