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.

Continuity of Care/Transition of Care Request Form

This document provides information about a Continuity of Care/Transition of Care request.

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, 7 a.m. - 7 p.m. CT

For details on information in other languages, click here.

Employer Portal

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Member Portal

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Find a Provider Service Area Map

Access a Doctor, 24/7/365

FirstCare Virtual Care—powered by MDLIVE lets you connect with a doctor from wherever you are. For more details, click here.

Talk to a Nurse
24-Hour Nurseline

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 1-877-505-7947 to get answers 24 hours a day, 7 days a week! TTY users can call 711.

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.

Population Health Management

Support for Your Health Needs

Employer Automatic Payments

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