First Choice Health Home : PPO Network : For Members : Benefit Information

Benefit Information

The First Choice Health Network is used in a wide variety of benefit plans. In general, your care will cost less and you will have lower out-of-pocket expenses when you choose to use a First Choice Health Network preferred provider.

• Please read your health plan booklet to understand your benefits
• Know what your responsibilities are before you and your family need care
• If you have benefit questions, call your insurance company or claim administrator
• First Choice Health Network is not an insurance company or claim administrator

In Case of Emergency

In the case of a life-threatening emergency, whether at home or away from home, seek the most immediate care available. If you are admitted to a hospital for an emergency, you, your doctor or the hospital may need to obtain retroactive authorization for the admission within the time specified by your benefit plan, or as soon as you are reasonably able to do so. To obtain authorization, call the number on your ID card.

Hospital Care

Some health care plans require pre-authorization of non-emergent hospital care. Check your health care ID card to see if your plan requires pre-authorization. If pre-authorization is required, you or your doctor must call the number printed on your ID card to get the necessary authorization before you are admitted to the hospital.

How to File a Claim

In most instances, First Choice Health preferred providers will file a claim for the health care services you receive. However, occasionally you may receive a bill for services. If so, be sure your name, member I.D. number, and insurance group number are written on the bill. Send the bill to the claims address on your ID card.

First Choice Health Network cannot provide specific eligibility, coverage or claims information. If you need a benefit & claims phone number, claims address, or pre-authorization phone number, please see our List of Payors. A payor is a contract holder, such as an insurer or a third party administrator, with First Choice Health Network that sponsors employer groups' access to our network of providers.

Specialist Care

Your health care plan may or may not require a referral from your primary care provider if you need specialty care. If your plan requires a referral, the process is easy:

• First, have your primary care provider select a specialist from your directory
• Second, have your primary care provider call the appropriate referral number on your insurance identification card
• Third, schedule your appointment with the specialist

If your plan does not require a referral, you may select a specialist from your directory and schedule an appointment at any time.

Not all specialty care may be covered by your health plan. For example, some health plans do not cover care from chiropractors, social workers, physician's assistants and others. Before you schedule an appointment, check the schedule of benefits in your member handbook, or call your insurance company to be sure you are covered for these services.

If you choose a non-First Choice Health preferred provider, your out-of-pocket cost for care is usually higher. Your member handbook, or your insurance company customer service representative, will be able to explain the level of benefits when you receive care from a non-First Choice Health Preferred Provider.

Women's Health Care (Washington)

Under Washington state law, women may self-refer to providers who specialize in the treatment of women's health care needs. This means a woman does not need a referral from her primary care provider in order to see a women's health care provider for the diagnosis and treatment of reproductive health services, gynecological care, maternity care, general examinations or preventive care, or medically appropriate follow-up visits for these services. This right to self-referral is not a guarantee of coverage. Before you schedule your appointment, you should:

• Call your insurance company or health plan administrator to be sure the care you want is covered
• Schedule your appointment with a recognized women's health care provider
• Be sure the women's health care provider is a First Choice Health preferred provider

The following providers are recognized as women's health care providers:

• An MD or DO (osteopath) who is a family or general practitioner, internist, obstetrician, or gynecologistist, obstetrician, or gynecologist
• A licensed physician's assistant for any of the above listed MDs or DOs
• An advanced registered nurse practitioner (ARNP) who specializes in women's health, family practice or midwifery
• Licensed midwife