Mandatory Disclaimers

For FirstCare HMO/PPO members, where applicable.    

Provider Network Access Plan for Members

Your FirstCare plan includes access to a network of providers (i.e., doctors, hospitals, other health care providers, etc.) to meet your health care needs. These providers are contracted with us and are considered "in-network." They are available to you for a full range of covered health care services. This plan provides insight to the process we use to develop and maintain adequate provider access. Click here to view the plan.
 

Out-of-Network Coverage for HMO Members

FirstCare Health Plans provides no benefits for services you receive from out‐of‐network providers, with specific exceptions as described in your evidence of coverage and below.
  • You have the right to an adequate network of in‐network providers (known as network providers).
  • If you believe that the network is inadequate, you may file a complaint with the Texas Department of Insurance at: www.tdi.texas.gov/consumer/complfrm.html.
  • If your HMO approves a referral for out‐of‐network services because no network provider is available, or if you have received out‐of‐network emergency care, the HMO must, in most cases, resolve the out‐of‐network provider's bill so that you only have to pay any applicable copayment, coinsurance, and out‐of‐network deductible amounts.
  • You may obtain a current directory of network providers at the following website: www.FirstCare.com/FindAProvider.com or by calling 1-800-884-4901 for assistance in finding available network providers. If you relied on materially inaccurate directory information, you may be entitled to have a claim by an out‐of‐network provider paid as if it were from a network provider.
 

Balance Billing Notice for HMO Members

A facility-based physician or other health care practitioner may not be included in FirstCare’s provider network. The non-network facility-based physician or other health care practitioner may balance bill FirstCare HMO members for amounts not paid by FirstCare—due to the provider being out-of-network. If you receive a balance bill from a facility-based physician or other health care practitioner, contact FirstCare Customer Service at the number on the back of your FirstCare member ID card.
 

OB/GYN Selection & Visitation—Attention Female HMO Enrollees

You have the right to select and visit an obstetrician-gynecologist (OB/GYN) without first obtaining a referral from your PCP. FirstCare Health Plans has opted not to limit your selection of an OB/GYN to your Primary Care Provider's (PCP) network. You are not required to select an OB/GYN. You may elect to receive your OB/GYN services from your PCP.
 

Notice of Special Toll-Free Complaint Number

Click here to view the notice of special toll-free complaint number for Behavioral Health services.
 

Telemedicine Medical Services & Telehealth Services

Any contracted FirstCare provider can provide telemedicine medical services and/or telehealth services, for certain circumstances and conditions, to a FirstCare member.
  • No pre-authorization is required by an in-network FirstCare provider. However, if an out-of-network provider is needed, pre-authorization is required. In these cases, FirstCare requires a 48-hour advance notice prior to the member receiving telemedicine services from an out-of-network provider.
  • Covered services are subject to all applicable copayments, coinsurance, and deductible amounts, not exceeding those for the same covered service provided in an in-person location such as a doctor’s office, clinic, or hospital.
If you have any questions, contact FirstCare Customer Service at the number on the back of your FirstCare member ID card.

 

Privacy Questions or Concerns?

Questions or concerns about your rights to privacy under HIPAA or NOPP? Call the FirstCare Compliance Hotline at 1.866.399.8161 or write to:
 
FirstCare Health Plans
Attn: Privacy Officer
12940 N. Hwy 183
Austin, TX 78750

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