*
* PLEASE READ FIRST BEFORE SELECTING
A FIRST HEALTH NETWORK PROVIDER * *
First Health PPO Network for Employees of HCA-Affiliated
Facilities
Enrolled in the $100, $200, $500, or $750 PPO
Plans
In
order to receive the highest level of benefits,
employees of HCA affiliates enrolled in the
above-named PPO plans must utilize HCA-affiliated
facilities and First Health network physicians.
NOTE: Not all physicians listed in the First
Health provider directory are associated with
or have admitting privileges to HCA-affiliated
facilities. Employees and their dependents
should confirm with the First Health network
physician prior to their appointment if they
are taking new patients and if they have admitting
privileges to an HCA affiliate when inpatient
and outpatient services are anticipated.
If your physician refers you for services outside of their office setting for physical therapy, lab or x-rays, e.g., it's important you use an HCA-affiliated facility if available to receive the highest level of benefit.
THE ABOVE-NAMED PPO
PLANS RECOGNIZE ONLY HCA-
AFFILIATED FACILITIES FOR THE HIGHEST PAYABLE
BENEFIT LEVELS.
The
First Health provider directory also includes
a comprehensive listing of First Health network
facilities; however, not all facilities listed
are HCA affiliates. To determine if medically
necessary services are available at an HCA affiliate,
participants must call CBCA, the third-party
administrator for the above-named PPO plans.
If CBCA determines that medically necessary
services are unavailable at an HCA affiliate,
participants must utilize a First Health network
facility to avoid penalties. If those services
are received from a First Health network facility,
participants will receive a discounted rate.
If care is not received at an HCA affiliate
or First Health network facility when it was
available, penalties will apply. Please refer
to the Summary Plan Description for
a detailed plan of benefits. All medical claims
and/or benefit-related questions should be submitted
to:
CBCA
P O Box 1479
Minneapolis, MN 55440-1479
800.422.0055
Member Services Representatives are available
from 7:30 a.m. to 7:00 p.m. Central, Monday-Friday
Behavioral Health Providers
Behavioral
health providers are not included in
the First Health network for HCA. The behavioral
health plan is administered by ValueOptions.
All services for mental health and/or chemical
dependency treatment or services, except for
the first 20 outpatient visits must be pre-certified
in advance. After visit 20, an outpatient treatment
report from your provider is required for benefits
to continue. Eligible providers are defined
as licensed psychiatrists, licensed clinical
psychologists, licensed or certified master’s
level clinical social workers, licensed or certified
masters level psychiatric nurse specialists,
or licensed professional counselors in the ValueOptions
network. For more information about behavioral
health benefits, contact ValueOptions
at 800.434.5100.
Directory Disclaimer
The
First Health Directory does not constitute a
recommendation of any hospital, physician or
other health care provider. The providers listed
are independent contractors and the First Health
network is not responsible for health care provided
or the omission of health care by these providers.
This
First Health Directory does not guarantee that
all services or all providers will be covered
under your health care plan. You must consult
your employee benefits Summary Plan Description,
as well as the medical claims administrator
listed above to determine what type of providers
and services are covered. Failure to refer to
these resources may result in lesser reimbursement
for certain medical expenses.
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