• About your plan
• How does it work
• ID Cards
• Family Doctor
• Consult Verification
• Specialist Care
• Emergency Care
• Pre-Certifications
• High Risk
• Prescription Drug Coverage
• Claims Procedures
• Frequently Asked Questions

Taking You Through Your New Health Plan

Learning how to use a new health plan can take some time. At DocFirst, we try to make this process as simple as possible. After you have reviewed this information you may still have some questions. If so, call the Customer Care Center at 1-800-793-9403. The following is an introduction to DocFirst and answers to potential questions you may have about your new health care plan.

How Does DocFirst Work?
DocFirst is designed to provide you with the freedom to choose your health care providers. Doc First requires that you select any family doctor of your choice and work with that doctor to meet your health care needs. In most cases, your family physician can identify and treat problems early on, preventing more serious illness. When necessary, a family physician can direct you to the specialist that is right for you.

DocFirst only requires you to take a few steps to get this kind of care. These steps are:

• Pick a family physician and identify this physician to DocFirst through the Family Doctor Identification Form.
  
  
• Contact your family doctor for your routine wellness screening, before seeking a specialist or after an emergency situation if you need follow up care. You confirm this consultation with DocFirst via the Consult Verification Form
  
  
• Show your ID card to all providers to get the best benefits available. Your ID card contains important billing information and telephone numbers to expedite your claim submission. If you need a new card, you may use our online form to request a new ID card. Show your ID card at the hospital to get the best benefits available.

How to Select a Family Doctor
A close family doctor/patient relationship is the cornerstone of DocFirst. You are free to select any family doctor you choose; therefore, we do not limit your choice to a list of physicians in a network. Employees and family members are asked to chose any family physician and see that physician for all his or her medical needs. If specialty care is required, you work with your family doctor to select the best course of care for you or your family. There are no restrictions on what specialist and facilities are utilized as long as the member works with the family doctor to seek specialty care.

You may already have a relationship with a family physician. If you and your family members already see a family doctor you can continue to visit this doctor. If you do not have a family physician, you must select a family doctor. You and your family members (spouse and dependents) can have the same doctor or different family doctors. In each case, this doctor must qualify as one of the following:

• A family practitioner
• A general pediatrician
• An internist
• General Practitioner

It is important that your family doctor meet this criteria. After you decide on a new or existing family doctor relationship, you must identify him or her to DocFirst. To do this you can either print the form and mail/fax it to us or complete and submit it online.

To mail or fax, select and print out the DocFirst Family Doctor Identification Form. You need Adobe Acrobat reader to view and print this form. If the form does not display on your screen, Click Here to get Acrobat Reader. It's free.

English Only Family Doctor Identification Forms

-- English Only - Select form below to print and mail -- Alcan Rolled Products Allen's Cedar DVCC, Inc. Glatfelter Mariott International, Inc. All other plans

Mail to the following.

DocFirst c/o LBA Health Plans

Remember that you can switch your family doctor at any time. Just notify DocFirst at 1-800-793-9403 or complete a new Family Doctor Identification Form. If you are having difficulty finding a family doctor good sources of information include: family, friends and co-workers or you can call our Customer Care Center.

Using the Consult Verification Form
Once you identify your family doctor to DocFirst, you can see that doctor for many of your health care needs. In the event that you need specialty care, you must consult your family doctor first. This consultation is verified to DocFirst with the Consult Verification Form. If your doctor has agreed to be a DocFirst member doctor, he or she will forward the signed Consult Verification Form on to DocFirst for you. If your doctor is not a member you can still see them and your benefits will not be affected but it is your responsibility to make sure the Consult Verification Form reaches DocFirst. After consulting with your family doctor, you may generally see any specialist you and your Family Doctor choose. Remember this simple requirement: You need a Consult Verification Form for visits to the specialist, specialist to specialist referrals, hospital admissions and follow up specialty care after emergency room or urgent care visits.

Print the Consult Verification Form using the links below
English Only Consult Verification Form
Spanish Only Consult Verification Form

Specialist Care
Seeking a Specialist
If you wish to visit a specialist for any medical care, you should consult with your Family Doctor. The family doctor is allowed to use his or her best professional judgement, to seek the most appropriate specialty care for the member. DocFirst does not limit its members facility and specialist care to a network because we believe the family doctor is in the best position to direct your care to the most appropriate site.

Have your family doctor sign a Consult Verification Form and send it to DocFirst. You must send the signed Consult Verification Form to DocFirst before visiting the specialist. If you do not inform your family doctor and do not send a Consult Verification Form, depending upon your employers plan design you may still receive benefits, but you could be responsible for a greater portion or all of the bill.

Currently under Specialist Care
If you are currently under a specialist’s care, just have your family doctor complete and sign a Consult Verification Form and mail it to DocFirst.

Specialist Ordered Testing and Hospital
If you are admitted to the hospital or if tests are ordered by a specialist, your Consult Verification Form from your family doctor for that specialty course of treatment will cover the hospital admission and test. Remember that you must still call for precertification.

Identification Cards
You will receive an identification card shortly after enrollment. You will need to show your identification card whenever you obtain health care services. This card serves as your Primary Select card for all medical services including prescription drugs. If you need a new card, you may use our online form to request a new ID card.

Emergency Situations
Immediate Situation
If you need emergency medical care, you should go immediately to the nearest emergency facility. You should contact your family doctor within 48 hours to advise him or her of your condition.

Hospital Admission
If you are admitted to a hospital during an emergency situation, you must contact your family physician and you must precertify this admission with DocFirst within 48 hours of admission.

Urgent Care Facilities
You should contact your family doctor first for all of your health care problems. If you need to visit an urgent care facility, you can do so. For any follow up care involve your Family Doctor.

Hospital Pre-Admission Certification
Hospital Pre-Admission Certification
If you plan to be admitted to the hospital for surgery or any other procedure, you are required to call for pre-admission certification at least 7 days prior to admission. You are required to call DocFirst within the first trimester of pregnancy and within 48 hours of an emergency admission, as well. DocFirst can be reached at 1-800-793-9403, 8:00 a.m. – 6:00 p.m. Monday through Thursday, and 8:00 a.m. - 5:00 p.m. Friday, EST.

High Risk Situations
DocFirst tries to identify high risk situations early on in the course of an illness. If you have a serious medical concern, our FutureHealth Nurse Care Managers are available to discuss your situation and provide you with options.

Many times a serious problem will be detected early on by DocFirst. You may then be contacted directly by our FutureHealth Nurse Care Managers. They offer you extra help in coping with your disease by easing administrative hassle and providing you the special services your condition may require. FutureHealth Nurse Care Managers who are working with you also eliminate the need for a Consult Verification Form. They will actively assist in the coordination of your care between your family doctor and other providers.

FutureHealth Nurse Care Managers are trained to help coordinate the many services you may need, educate you on the specific illness or problem you may have and help you evaluate and make decisions on the proper care you should seek. All of the information that FutureHealth Nurse Care Managers receive is strictly confidential. This personalized assistance is included as part of your DocFirst plan at no extra cost. You can learn more about this service by going to myfuturehealth.net.

Prescription Drug Coverage

You may have prescription drug coverage provided under the plan through a Pharmacy Benefit Manager (PBM). The PBM allows you to receive covered drugs from selected local pharmacies. They may also operate a mail order drug program on your behalf. You can find more detailed information about your PBM and what is covered or excluded in your plan’s Summary Plan Document (SPD).

If you would like to visit the web site of the PBM who operates the prescription drug program to find pharmacies in your area, refill mail order prescriptions on-line or view the current formulary drug list then click on the logo of the PBM that matches the one on your medical I.D. card. Make sure you click on the correct PBM for your plan because each operates differently.

 

Claims Procedures

• All medical claims should be mailed to DocFirst
• Claims are examined and paid according to the plan
• Some physicians will bill DocFirst directly. If your physician bills directly, payment will be made promptly
• If your doctor requests payment from you at the time of visit, fill out a claim form below and mail it to DocFirst. You will be reimbursed promptly according to the benefit schedule. Our address is DocFirst, P.O. Box 17098, Owings Mills, MD 21117.
  English Only Claim Forms
  English Only - Select & Print Claim Form Below Alcan Rolled Products Allen's (Dental) Allen's (Medical) Angelica Nurseries Cedar Colliers Pinkard DVCC, Inc. (Dental) DVCC, Inc. (Medical) Glatfelter HBP, Inc. Ketchum Marriott International, Inc. Miller + Long (Dental) Miller + Long (Medical) Nextel Communications, Inc. North American Housing Pilot Air All other plans
  
  English/Spanish Claim Forms
  (Spanish Form is on the second page)
  English/Spanish - Select & Print Claim Form Below DVCC, Inc. (Dental) DVCC, Inc. (Health Claim) Marriott International, Inc. Miller + Long (Medical)
  
  You need Adobe Acrobat reader to view and print this form. If the form does not display on your screen, Click Here to get Acrobat Reader. It's free.
  
  
• For claims questions and problems call: 1-800-793-9403, Monday through Thursday 8:00 – 6:00 p.m., and Friday 8:00 - 5:00, EST.