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