- Insurer Name : HealthFirst
- Address : 6450 US Highway 1, Rockledge, FL 32955
- Phone Number : 1-866-463-6743
- Website : https://www.healthfirst.org/
- Medicare/Medicaid/TRICARE Support : Yes (Medicare, Medicaid)
- Specific Plans Offered : Offers Medicare Advantage plans and Medicaid managed care plans. HealthFirst Plans
Frequently Asked Questions:
What is prior authorization?
Prior authorization is a process where your doctor must obtain approval from Healthfirst before a specific prescription medication is approved for you to pick up at the pharmacy. Without this approval, the medication may not be covered, and you might not be able to receive it. healthfirst.org
How do I know if a medication requires prior authorization?
To determine if a medication requires prior authorization, check your plan's formulary—a list of covered and approved prescription medications. The formulary will indicate which drugs need prior authorization. healthfirst.org
What happens if my doctor doesn't obtain prior authorization?
If your doctor doesn't secure prior authorization for a medication that requires it, Healthfirst may not cover the medication, and it might not be available when you attempt to pick it up from the pharmacy. healthfirst.org
Are there upcoming changes to prior authorization requirements?
Yes, starting April 6, 2025, Healthfirst will add prior authorization requirements for selected medical services. healthfirst.org
How can I find the necessary forms for prior authorization?
You can access the required forms for prior authorization on the Healthfirst website's "Find a Form" section. If you're uncertain which form you need, call the number on the back of your Healthfirst Member ID card for assistance. healthfirst.org
What should I do if my prior authorization request is denied?
If your prior authorization request is denied, you have the right to appeal the decision. Healthfirst provides information on coverage decisions, appeals, and complaints for Medicare plan members on their website. healthfirst.org
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