|
Q. How do I
go about finding a doctor that will see me or a family
member?
A. You can call
REFERRAL ONE at 625-2000 or 1-800-638-7081 and they
will assist you in finding the right doctor for your
needs. They will also be glad to assist you in scheduling
appointments and answer questions about location, education
and insurance requirements.
Q. How do I
know what type of doctor to see for a particular problem?
A.
Your family doctor will be happy to refer you to a specialist
for a particular problem or condition. If you do not
have a family doctor, you can call REFERRAL ONE at 625-2000
or 1-800-638-7081 for assistance.
Q. How do I
find a doctor that will see my children?
A. Pediatricians
are doctors that specialize in the treatment of children.
Family Practice doctors also see children as well as
adults. You can call REFERRAL ONE at 625-2000 or 1-800-638-7081
and they will assist you in finding a doctor for your
children.
Q. How do I file an
insurance claim?
A. If your provider
is a member of HealthFirst, they will file the claim
for you with your insurance company. Or the claim may
be mailed to the claim submission address on your insurance
card. Be sure that the insured’s name, address
and Social Security Number are included with the claim.
Q. How do I
know if a procedure or service is covered by my insurance?
A. You should call
the phone number printed on your insurance card. If
you do not understand the procedure or service, you
should request that your physician call the insurance
company for you.
Q. Do I need
to pre-certify with my insurance company before going
to the hospital?
A. Not all procedures
require pre-certification, however it is best to call
the number printed on your insurance card and inquire.
Your doctor’s office can also assist you with pre-certification.
If you are hospitalized it is usually necessary to notify
the insurance company. A family member can call for
you. You may suffer a payment penalty if you fail to
pre-certify.
Q. What should
I do if I don’t understand the insurance company’s
payment?
A. You should call
the phone number printed on your insurance card and
discuss your claim with a company representative. If
you do not agree with the payment, you may file an appeal
with the insurance company. Your employer or insurance
agent can assist you in filing an appeal.
|
