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Have any questions?

Healthfirst
100 Church Street
New York, NY 10007

Want to become a Healthfirst member? Have a question about our benefits?

Contact us at:

Medicaid, Child Health Plus, and Family Health Plus
1-866-463-6743

Medicare
1-877-237-1303
TDD/TTY English
1-888-542-3821
TDD/TTY Español
1-888-867-4132
Monday-Friday, 8:30 am to 6 pm

Already a Healthfirst member? For answers to your questions, contact us at:

Medicaid, Child Health Plus, and Family Health Plus
1-866-463-6743
Monday - Friday, 8 am to 6 pm

Medicare
1-888-260-1010
TDD/TTY English
1-888-542-3821
TDD/TTY Español
1-888-867-4132
Monday - Sunday, 8 am to 8 pm

Leaf Plans
1-888-250-2220
TDD/TTY English
1-888-542-3821
TDD/TTY Español
1-888-867-4132
Monday - Friday, 8 am to 8 pm

Healthfirst Small Group and Healthy NY Small Group
1-888-260-1010
TDD/TTY English
1-888-542-3821
TDD/TTY Español
1-888-867-4132
Monday - Friday, 8 am to 8 pm


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Seeing a Specialist

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 PCP sends you to another doctor (also known as a “referral”), Healthfirst will pay for your care.
  • Depending on your plan, you may be responsible for your usual copay. Call us if you have questions about your copay.
  • Make sure the specialist takes Healthfirst insurance. If you think a specialist does not take Healthfirst or meet your needs, talk to your PCP about seeing a different specialist.
  • There are some treatments and services that your doctors must ask Healthfirst to approve before you can get them. Your doctors should tell you if you need a treatment approval. They will also help you get the approval.

Things to Know About Specialist Doctors

01

When would I need to see a specialist?

 

If you need special care that your Primary Doctor cannot offer, he or she will recommend a specialist who can help you.

 

Some examples of specialists you might need to see are:

  • Podiatrist: foot doctor
  • Ophthalmologist: eye doctor
  • Orthopedist: bone doctor
  • Oncologist: cancer doctor
  • Endocrinologist: hormone doctor who treats problems like diabetes and thyroid issues
  • Dermatologist: skin doctor
  • Cardiologist: heart doctor

> Click here to find specialists that take Healthfirst insurance

02

How do I choose a specialist?

 

Your Primary Doctor should recommend a specialist to you that takes Healthfirst insurance. You can also call Member Services – we’ll help you find a good specialist near you.

03

What if Healthfirst doesn't cover the kind of specialist I need?

 

If we do not cover a certain type of specialist, we will get you the care you need from a specialist outside of the Healthfirst network. Here’s how:

  • You or your Primary Doctor can call Healthfirst’s Medical Management Department at 1-888-394-4327 (Monday to Friday, from 8:30 AM to 5:30 PM). Medical Management will help you find the right specialist to treat your condition.
  • If you need to see an out-of-network specialist, your Primary Doctor can send us an “Authorization Request” for that visit.
  • If we deny your request to see a specialist outside of your Healthfirst plan or program, you can appeal our decision. Call us for help on how to appeal a decision.

If your Primary Doctor or Healthfirst refer you to an out-of-network doctor, you are not responsible for any costs, except for copays. For more information, please contact Member Services.

 

Last update 2013-09-04 17:35