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Atlantis Health Plan COORDINATION OF BENEFITS POLICY

Coordination of Benefits, ("C.O.B.") is an important part of Atlantis Health Plan's overall objective of providing health care to members on a cost effective basis and is required by state statute and insurance carriers in situations where members have more than one insurance coverage. Members may not be billed, either up front or after the fact, for covered services rendered except for any co-payments for which the member may be responsible. There may also be circumstances where you, as a contracting provider, are excluded from billing another carrier for balances even if a member has other insurance. Contracts with Atlantis Health Plan require physicians to accept Atlantis Health Plan's payment as payment in full. The following billing procedure applies to all Atlantis Health Plan members, whether their coverage with Atlantis Health Plan is primary or secondary:

Office patients will pay the co-payment at the time of visit and the primary carrier is billed for the visit according to your usual fees.

For hospital patients, no co-payment is required and you must bill the primary carrier according to your usual fees.

If Atlantis Health Plan is the secondary insurance, attach the Explanation of Benefits (E.O.B.) from the primary carrier and Atlantis Health Plan may then be billed the remaining balance due.

Under no circumstances may the member be directly billed except for the co-payment due.

Members with primary insurance other than Atlantis Health Plan may choose not to participate as an Atlantis Health Plan member and wish to continue using only their primary benefits (this will be an unusual circumstance). In this case you may obtain a written waiver from the member stating that they do not wish to participate as an Atlantis Health Plan member, explaining that Atlantis Health Plan will not be responsible for any payments of any kind associated with the visit. Under these circumstances the physician may bill according to their usual methods. This must be in writing and attached to the member's chart for future verification should it be required.

Since the members accept Atlantis Health Plan benefits by their participation in the C.O.B. program, they are legally responsible to adhere to the rules and regulations required of all Atlantis Health Plan members (use of the Primary Care Physician, prior approval for out-of plan services). If any of these regulations are violated, reimbursement will not be forthcoming. Any specific questions regarding Coordination of Benefits should be directed to Atlantis Health Plan's Corporate Office.

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