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Referrals to Atlantis Health Plan Specialty Care Centers
You as a new Member upon enrollment, or a current Member upon diagnosis with a life-threatening condition or disease or a degenerative and disabling condition or disease, either of which requires specialized care over a long period of time, may request a referral to an Atlantis Health Plan Specialty Care Center.
Evaluation of your condition will be discussed between the Atlantis Health Plan Medical Director and requesting provider to determine if such a referral is appropriate. The referral will be provided pursuant to a treatment plan that has been approved by the Atlantis Health Plan Medical Director. You, your PCP, or Atlantis Health Plan Specialist may call the Atlantis Health Plan Utilization Department and request a referral to an Atlantis Health Plan Specialty Care Center.
Changing Your Specialist
If you are dissatisfied with a specialist that you have been referred to, please contact your PCP's office. If a change is unable to be effected by your PCP's office, contact the Atlantis Health Plan Member Services Department for assistance.
Out-Of-Network Specialist Care and Specialty Care Centers
With the exception of care for Emergency Conditions, services must be approved by your participating Primary Care Provider and provided by a Participating Provider. Under the following circumstances, however, upon referral, you may see a specialist or provider that is not in the Atlantis Health Plan Network or receive ongoing specialty care from non-participating providers.
This care will be provided at no additional cost to you beyond what you would otherwise pay for services received within the network.
- If Atlantis Health Plan does not have a health care provider with appropriate training and experience in the Network to meet your particular needs, a referral will be given to an appropriate provider outside the Network.
- If Atlantis Health Plan deems it necessary to use providers outside the Network and approves such care in writing.
- If you have been given a positive or negative diagnosis of cancer or a recommendation of a course of treatment for cancer, Atlantis Health Plan will approve coverage for a second medical opinion from a non-participating specialist, including but not limited to a specialist affiliated with a specialty care center for the treatment of cancer.
- If you have a life-threatening condition or disease or degenerative and disabling condition or disease which requires prolonged specialized medical care, Atlantis Health Plan may approve a referral to a specialist to provide and coordinate your primary and specialist care. Atlantis Health Plan may limit the number of visits or period of authorization and require the specialist to provide information to your Primary Care Provider.
- If you have a life-threatening condition or disease or degenerative and disabling condition or disease, which requires prolonged specialized medical care, Atlantis Health Plan may approve a referral to a designated or accredited specialty care center. Atlantis Health Plan does not cover travel expenses associated with referrals to specialty care centers even if significant travel is required unless travel is included in the rate of payment negotiated with the specialty care center.
You, your PCP, Atlantis Health Plan Specialist, or Out-of-Network Provider may call the Atlantis Health Plan Utilization Department and request a standing referral to an Out-of-Network Specialist and/or Specialty Care Center.