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If you need additional information, please visit ASES website through the ASES button

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Besides your PCP, you may also need to see other doctors and health care providers, like specialists. A specialist is a doctor who gives care for a certain illness or part of the body. One kind of specialist is a cardiologist, who is a heart doctor. Another kind of specialist is an oncologist, who treats cancer. There are many kinds of specialists.

Besides specialists, you may also need to go to other healthcare professionals and healthcare facilities to get care, like laboratories, x-ray facilities, or hospitals. The doctors, other health care professionals and service facilities that work with First Medical and your Primary Medical Group are called the Preferred Provider Network.

The other doctors, other health care professionals and service facilities that work with First Medical are called the General Network. When you sign up with First Medical, they will mail you a Provider Directory for the Preferred Provider Network and the General Network. You can find these lists in the Provider Directory section. Your Primary Medical Group and First Medical Service Offices also have a copy of the lists.

For more information about how Vital works if you have Medicare, look at Part 8 of your Enrollee Handbook.

Preferred Provider Network

The doctors, other health care professionals and services facilities who work with your Primary Medical Group are called the Preferred Provider Network.

There are benefits to seeing the doctors, other health care professionals and service facilities in the Preferred Provider Network:

• You can visit any of the doctors and service facilities in the Preferred Provider Network for free.
• If you visit the doctors, healthcare professionals and service facilities in your Preferred Provider Network, you don’t need to go to your PCP first to get a referral.
• If you get any of the following services within the Preferred Provider Network, you don’t need your PCP to sign off:
  • Prescription medicine
  • Laboratory tests
  • X-rays

To get more information about your Preferred Provider Network, you can:

1. Call First Medical at 1-844-347-7800; TTY/TDD users should call 1-844-347-7805.

2. Call Vital Call Center at 1-800-981-2737.
3. Go to First Medical Service Offices.
4. Call your Primary Medical Group.

General Network   

The General Network is the health care professionals and services facilities that work with First Medical and that support the Primary Medical Groups. If the doctor or provider you need to see isn’t in your Preferred Provider Network, they might be in First Medical General Network. You can see any doctor or provider in First Medical General Network as long as you go to your PCP first to get a referral. If you need a referral, your PCP must give you one during your visit or within twenty-four (24) hours after you ask for one.

Your PCP will coordinate your visits to doctors or providers in the General Network.

You might need to pay money for these visits. Look at Part 4 of your Enrollee Handbook for more information about payments.

If you get any of the following by a provider in the General Network, your PCP will have to sign off:

• Prescription medicine
• Laboratory tests
• X-rays

Out-of-Network

A doctor or other provider who does not work with First Medical is called an Out-of-Network provider. If you need to see a doctor or other provider who is Out-of-Network, you must get a referral from your PCP..

If you feel that First Medical or your doctors are not following these rules, you can call First Medical at 1-844-347-7800; TTY/TDD users should call 1-844-347-7805 and tell them that you need to make a complaint. You can also call the Patient Advocate Office at 1-800-981-0031 or ASES at 1-800-981-2737.