Atlantis Health Plan - Members (member handbook

Atlantis Health Plan Member Handbook - HMO

Table of Contents

Important Telephone Numbers		2
Atlantis Health Plan		3
Atlantis Health Plan Identification Card		3
The Primary Care Provider		4
Changing Your Primary Care Provider		5
Specialty Services		5
Specialist as Primary Care Physician PCP		5
Second Opinions		6
Referrals		6
Standing Referrals to Atlantis Health Plan Specialist		6-7
Referrals to Atlantis Health Plan Specialty Care Centers		7
Changing Your Specialist		7
Out-of-Network Specialist Care and Specialty Centers		7-8
Transitional Care		9
Hospital Services		9
Urgent Care After Hours		10
Emergency Care		10-12
Routine Gynecological Care		12
Obstetrical/Maternity Care		12
Hospice		12
Behavioral Health Care Services		12-13
Prescription Drugs		13
Vision Care		13
Chiropractic Care		13
Experimental and/or Investigational Treatment/Procedures		14
Informed Consent and Advance Directives		14-15
Submitting Claims		15-16
Covered Services		16
Copayments		16-17
Excluded Services		17
Pre-authorization		17
Utilization Review		17-18
Appeal Procedures		19-20
Internal Procedures		20-21
External Procedures		21-23
Member Rights and Responsibilities		23-24
Member Services Department		25
The Grievance Process External Procedures		25-27
Membership Issues		27
Member Eligibility		27
Enrollment		27-28
Enrollment Changes		28
Benefit Coverage		28
Coordination of Benefits for Group Members		28-29
Termination of Coverage		29
Continuation of Group Coverage		29
Conversion to Individual Membership		30
Member Acknowledgments		30
Non-English Speaking Members		30
Medical Information and Records		30
Governing Agreement		30
Independent Contractors		30