Seeing a Specialist

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

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.

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.