Answers to Questions You May Have
About Healthfirst Doctors and Hospitals
Let us help you find answers to common questions about Healthfirst doctors and hospitals. To start, click on a topic below that is the best match for your question.
Still have questions? Please Contact Us. We’re here to help you get the answers you need.
Questions about Healthfirst Doctors and Hospitals
Your Primary Doctor (also known as a “Primary Care Doctor”, “Primary Care Physician”, or “PCP”) is a doctor who is trained to give you basic health care. This will be the first doctor you see for most of your health needs, and to make sure you stay healthy.
If you do not choose a PCP when you sign up for your plan or program, Healthfirst will pick one for you. You are allowed to choose a different PCP at any time – just call us to make the change.
You can choose a different PCP for every member of your family that is covered by Healthfirst, or you can choose one PCP to take care of your whole family.
A “specialist” is a doctor who treats only certain parts of the body, certain health problems, or certain age groups. For example, cardiologists treat only heart problems, and oncologists treat people who have cancer.
If you need special care that your Primary Doctor (“PCP”) cannot offer, he or she will recommend a specialist who can help you.
- If your doctor leaves Healthfirst, we will let you know within 15 days of the doctor telling us he or she is leaving the network. We can then help you find a new Primary Doctor.
- If you are more than 3 months pregnant, or if you are receiving ongoing treatment for a health condition, Healthfirst may cover that doctor’s costs for a short time:
- If you are pregnant, you may continue to see your doctor for up to 60 days after your baby is born.
- If you are seeing a doctor for an ongoing condition, you may continue seeing him or her for up to 90 days. You will then need to see a Healthfirst doctor for treatment. Please talk to your current doctor about the best way to change to a Healthfirst doctor.
Important Note: Your current doctor must agree to work with Healthfirst during this 90-day period. If any of these conditions apply to you, or you have other questions, check with your Primary Doctor or call Healthfirst. We’re here to help.
If my Primary Doctor refers me to an out-of-network specialist or facility and the service is denied by Healthfirst, will I be responsible for the cost?
No. This situation is known as “plan-directed care.” As a Healthfirst member, you are not responsible to pay if a Healthfirst network provider referred you to the provider who performed the denied service. If you believe you were instructed by a Healthfirst network provider to receive the denied service, please contact Healthfirst Member Services at:
Medicare: 1-888-260-1010, TTY (English) 1-888-542-3821, TTY (Spanish) 1-888-867-4132, 7 days a week, 8:00am to 8:00pm
Medicaid, Child Health Plus and Family Health Plus: 1-866-463-6743, Monday to Friday, 8:00am to 6:00pm