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What are
the advantages of using a health care provider
in the First Health
Network?
Under your group health plan, you are free to
decide whether to use a First Health provider, but there
are many advantages to doing so:
- They will file health insurance claims for
you
- They will collect only patient co-payments,
not the full amount of the charges
- Their services will most likely cost you
less because of First Health’s contract rates with
them, and in some cases, because your health
plan pays higher benefits for using First Health providers
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How do I identify myself
as a First Health member?
You should show your health plan identification
card whenever you use a provider’s health
services. The “First Health” logo on your card
identifies you as a First Health member.
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Should I choose a primary
care physician?
It is to your advantage to establish a close relationship
with a primary care physician so that he or she
can become familiar with your health care needs.
However, you are not required to select a primary
care physician.
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Do I need to get a referral
to see a specialist or other provider?
Whenever additional services are required for
diagnosis and treatment (e.g. specialists, laboratories,
radiology facilities or hospitals), you should
remind your physician that you are a First Health member
and ask to be referred to a First Health provider. Be aware
that not all providers in a single office location
necessarily participate in the First Health
Network. You should always confirm participation
before receiving services from provider.
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What if I need to be admitted
to a hospital or other facility for treatment?
Whenever a member requires admission to a hospital
or behavioral health facility, First Health reviews the
case to ensure that you receive the most appropriate
services. Many services can be safely performed
on an outpatient basis. To ensure that planned
services are appropriate to your needs, a “preadmission
review” should be performed before any scheduled
(nonemergency) admission to a participating First Health
facility. Ask your physician to call the review
organization listed on your health plan card,
and show your card to the admissions personnel
at the facility when you are admitted.
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Where do I go for emergency
services?
If possible, contact your primary care physician
if you require emergency services—he or
she will instruct you about where to go for the
most appropriate treatment. Preadmission review
is not required for emergency admissions to First Health
or non-First Health hospitals or behavioral health facilities.
However, you should let the admitting physician
know that you are a First Health member and must call the
review organization listed on your health plan
identification card within 24 hours or the first
business day after being admitted.
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What are my financial
responsibilities?
When you use a First Health provider for services covered
under your health plan, you are responsible for
paying only your deductible, co-payment (if applicable)
and coinsurance. Your health plan’s explanation
of benefits (EOB) should show both the billed
charges and the First Health rates for services. You are
not responsible for paying the difference between
these amounts.
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What about behavioral
health services?
Your health plan may include coverage for behavioral
health services such as:
- Professional providers such as mental health
counselors and psychiatrists
- Outpatient mental health facilities and psychiatric
facilities/hospitals
- Chemical dependency recovery services programs
Preadmission review is typically required for
access to most behavioral health facilities. Please
check your health plan to determine what it covers.
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Where can I get more information?
For answers to your questions about health benefits
and eligibility, please call the benefits manager
for your health plan.
If you have questions about a specific claim,
contact your claims administrator.
For the most up-to-date information on the First Health
Network, visit the electronic
directory.
If you need additional assistance, call First Health toll
free at 1-888-685-7774. As provider participation
in the First Health
Network does change, you should always confirm
participation prior to receiving services. You
can also contact providers directly to obtain
more information on the services they offer.
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