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. To obtain authorization, call the number on your ID card.
Hospital Care
Some healthcare plans require pre-authorization for non-emergent hospital care. Check your healthcare benefit plan and/or 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 PPO Network (FCH PPO) preferred providers will file a claim for the healthcare services you receive. However, occasionally you may receive a bill for services rendered. If so, be sure your name, member ID number, and insurance group number are written on the claim form. Send the claim form to the claims address on your ID card. Contact your benefit plan administrator using the information on your ID card to obtain a claim form.
First Choice Health PPO Network (FCH PPO) cannot provide specific eligibility, coverage or claims information. To obtain specific eligibility, coverage or claims information, reference your benefit plan document or ID card for a benefits and eligibility phone number.
Specialist Care
Your benefit plan may or may not require a referral from your primary care provider for specialty care. If your plan requires a referral, the process is easy:
- Have your primary care provider select a specialist from your available network(s)
- Have your primary care provider call the appropriate referral number on your ID card
- You or your primary care provider will schedule your appointment with the specialist
If your plan does not require a referral, you may select a specialist from your available network(s) and schedule an appointment at any time. In some cases your benefit plan may use separate networks for certain services such as vision, mental health and chemical dependency.
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 benefit plan document, or call your healthcare company to be sure you are covered for these services.
If you choose an out-of-network provider, your out-of-pocket cost for care is usually higher. Your benefit plan document, or your healthcare company customer service representative, will be able to explain the level of benefits when you receive care from an out-of-network provider.
Women's Healthcare (Washington)
Under Washington state law, women may self-refer to providers who specialize in the treatment of women's healthcare needs. This means a woman does not need a referral from her primary care provider for the diagnosis and treatment of reproductive health services, gynecological care, maternity care, general examinations, 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 health plan administrator to be sure the care you want is covered
- Schedule your appointment with a recognized women's healthcare provider
- Be sure the women's healthcare provider is a FCH PPO preferred provider
The following providers are recognized as women's healthcare providers:
- An MD or DO (osteopath) who is a family or general practitioner, internist, obstetrician, or gynecologistist
- 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