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The First Health® Network Frequently Asked Questions
What you need to know about your Oxford coverage through The First Health Network
What is The First Health Network?
Oxford offers The First Health Network (formerly The AFFORDABLE® Medical Networks) to certain Members residing outside Oxford's service area. It is the largest independently-contracted hospital and physician network in the nation. The First Health Network consists of 3,600 hospitals and nearly 332,000 outpatient care providers, including physicians, radiologists, specialists, laboratories, and ancillary providers. Ninety percent of the entire U.S. population has access to physicians and hospitals that participate with The First Health Network.
What kind of value do I get with providers who participate in The First Health Network?
Oxford has chosen to offer The First Health Network because, with The First Health Network, you have access to providers who earn consistently high patient-satisfaction ratings. Hospitals and doctors must meet and maintain consistent standards, similar to those set for Oxford participating hospitals and physicians. Providers who are selected for participation in The First Health Network must have admitting privileges at a First Health hospital and must satisfy specific credentialing requirements. Eighty-four percent of physicians in The First Health Network are board-certified. First Health monitors each physician's practice patterns after acceptance into The First Health Network.
Do I need to designate a primary care physician (PCP) in The First Health Network?
No, you do not need to choose a PCP. However, in order to receive in-network benefits, it is your responsibility to use physicians, specialists, and hospitals that participate in The First Health Network. Otherwise, Oxford will consider covered services out-of-network and will reimburse these services subject to your plan's deductible and coinsurance. When using doctors who participate in The First Health Network, don't forget that Oxford requires a small copayment to be paid at the physician's office.
What should I do when I visit a doctor or hospital?
Your Certificate of Coverage details
your rights and responsibilities. Remember that if your doctor recommends
a hospital stay or surgical procedure, you must precertify. To precertify
a procedure, please call Oxford's Member Services Department at 888-201-4111 at least fourteen days prior to the hospital admission,
surgery, or diagnostic procedure. Remember: Pre-certification is your
responsibility, not the doctor's. Please have your Member ID number ready when you call.
What do I do in an emergency?
In a medical emergency, go to the nearest emergency room (ER). If you are treated and then released, you will be responsible for a small ER copayment. That copayment will be waived if you are admitted. In these cases, all services are covered on an in-network basis, regardless of whether the treating physician participates in The First Health Network. Please note, if you are admitted to the hospital through the ER, you are required to notify Oxford Member Services within 48 hours. Remember to carry your Oxford ID card, which has your Member ID number on it.
How will hospitals and doctors know that I have access to The First Health Network?
Oxford provides Members with an ID card on which appears both the Oxford and the First Health logos. Each Member will also be given a provider directory that lists the hospitals, physicians, laboratories, radiologists, and other providers in the area that participate in The First Health Network. Remember, in order to receive in-network benefits, you must use participating providers in The First Health Network.
Can I find a First Health doctor over the phone?
The First Health telephonic provider directory is a service that enables you to locate a hospital, physician, or any other outpatient care provider that participates in The First Health Network, over the telephone. This service can help you:
- locate a doctor or hospital by specialty within a specific number of miles from your house
- confirm whether a doctor is part of The First Health Network
- nominate a doctor to become part of The First Health Network
How do I use the First Health telephonic provider directory?
Simply call 800-486-9446, Monday through Friday, 8 AM to 10 PM (Eastern Standard Time). Spanish-speaking representatives will be happy to assist you, if required.
Can I find a First Health provider online?
Yes. You can obtain a listing of network providers by accessing the First Health web site at:
The First Health online directory enables you to search for a network provider by zip code, city, or county. The directory also indicates where participating providers have admitting priviledges and, in some cases, provides the driving directions to network providers.
What if my physician is not in The First Health Network?
If the provider does not participate in The First Health Network, benefits for covered services are payable at a lower level through the out-of-network portion of your plan, as defined in your Certificate of Coverage. Please consult your benefit plan, or call Oxford Member Services for details.
If I want to go to a specialist, do I need a referral?
No. Referrals are not necessary for Oxford Members who access The First Health Network, but the specialist must participate in The First Health Network to obtain benefits at the in-network level.
Where can I get answers to other questions that I may have?
Call an Oxford Member Service Associate at 888-201-4111. Member Service Associates are trained to provide you with information regarding your coverage, policies and procedures, and claims questions. They are available Monday through Friday, 8 AM to 6 PM. Please have your Oxford Member ID number ready when you call. If your question is about providers who participate with The First Health Network, please access the First Health web site, or call the First Health telephonic provider directory at 800-486-9446.
What happens if I am referred to a physician who does not participate in The First Health Network?
If you receive covered services from a provider who does not participate in The First Health Network, you will be covered on an out-of-network basis and subject to your deductible and coinsurance requirements. Remember, you have control over how you are covered. You receive network coverage only when you receive covered services from a provider who is a member of The First Health Network. You receive out-of-network coverage when you receive covered services from providers who are not part of The First Health Network.
If I am hospitalized by a participating First Health physician, how will I be covered?
In order to maximize your coverage for any hospitalization under this plan, please ask your physician to admit you to a hospital that participates in The First Health Network. Please also ask your physician to coordinate any specialty care that you may need (including radiologists, anesthesiologists, etc.) through specialists who participate in The First Health Network. You will receive in-network benefits only for covered services provided by a physician who participates with The First Health Network.
How are treatment decisions made?
Decisions regarding treatment are always made between the patient and physician. As a patient, you are free to choose your health care provider based on your evaluation of his or her qualifications. Providers who participate in the network are independent contractors. The First Health Network assists in identifying the most cost-effective treatment, and honors the integrity of the patient-physician relationship.