Important Plan Information

We know that health insurance can be confusing, so we've gathered information on the topics listed below to help explain FirstCare's payment policies and other important aspects of your plan's coverage.
 

Click on any of the topics below for more details.  

Out-of-Network Liability & Balance Billing

This is when out-of-network providers bill patients for the balance between the amount charged to their patients and what FirstCare has already reimbursed

Retroactive Denials

A previously paid claim can be reversed by FirstCare—this is a retroactive denial.

Medical Necessity & Prior Authorizations

Medically necessary care is health care resulting from an illness or injury, and, for some services, requires prior authorization by FirstCare.

Prescription Drug Exception Timeframes

You or your physician can ask FirstCare to make an exception to our coverage rules on your prescription drug coverage.

Concurrent Review

This review helps us ensure you are receiving the right care, in the right setting, for your condition.

Questions? Contact Us!

If you have any questions about your plan, your benefits, or FirstCare—our Customer Service team is standing by, ready to assist you.
  • Please call us at 1.800.884.4901 (HMO) or 1.800.240.3270 (PPO), Monday through Friday, 8 a.m. - 5 p.m. CT; or
  • Email our Customer Service team at cservice@firstcare.com.

For details on information in other languages, click here.

FirstCare is here to help.

Contact us today!

Resources

Find a Provider Service Area Map

Ask the Pharmacist

Have a question about a specific drug, or a drug benefit in your plan? Email our Pharmacist for the answers you need!

Talk to a Nurse—Nurse24™

Need care advice? Should you see a doctor? Get the info you need today! FirstCare members can talk to a nurse 24/7 by calling 1.855.828.1013 to get answers 24 hours a day, 7 days a week! TTY users can call 7-1-1 or  1.800.955.8771. Voice communication is available at 1.800.955.8770.

Utilization Management

Ever wonder how we decide what services to authorize for our members? Our utilization management (UM) decisions are based on medical evidence and consensus of health care professionals. For more details, click here.

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