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Frequently Asked Questions

Q:

How do I change my Primary Care Physician?

Call Member Services at (210) 358-6262 or toll-free at (877) 698-7032 and a representative can help you designate a new primary care physician. You can also request to change your primary care physician on our website by submitting a secure request through our secure member portal. Click on "contact us," then "send a secure request to Member Services."


Q:

Is a referral or authorization required to see a specialist?

Although Community First does not require a referral to see a specialist, some specialists require a referral from your PCP in order to see you. You should check with your PCP if a referral is required to see a particular specialist. Additionally, some services require a pre-authorization from Community First before you receive services. Your PCP will take care of this request for you. You can call Member Services to find out if a certain service requires authorization.

Services that do not require a referral are: 

  • Behavioral health services
  • OB/GYN services
  • Vision exams from an optometrist and ophthalmologist
  • Family planning services


Call Member Services if you need assistance finding a provider or with scheduling an appointment at (210) 358-6262 or toll-free at (877) 698-7032.


Q:

What emergency, after hours, and urgent care services are available?

Emergency Care:

Emergency care includes those health care services you receive in a hospital emergency room or comparable facility to evaluate and stabilize medical conditions, including behavioral health conditions. These conditions are of a recent onset and severity (such as severe pain) that require immediate attention.

In a medical emergency, call 9-1-1 or go to the nearest emergency room. Call your primary care physician as soon as possible after you get care so that he or she can help you arrange follow-up care.


Urgent Care

Urgent medical care is when you are sick or hurt, and need help within 24 hours to keep from getting worse. You should call your Primary Care Physician, who will direct you based on your symptoms. You may also call Member Services. We have a nurse advice line, available 24 hours, 7 days a week. They can give you guidance based on your situation.



After Hours Care

Illnesses and injuries sometimes occur after normal office hours. If you get sick or injured after hours, you should call your primary care physician. He or she has made arrangements to have their calls answered 24 hours a day, 7 days a week. You can also call Member Services. We have nurses who can help you 24 hours a day, 7 days a week. The nurse might refer you to an urgent care center, the hospital emergency room, or to a doctor who is open after routine office hours. The nurse might also give you home advice. Call Member Services at (210) 358-6262 or toll-free at (877) 698-7032.


Q:

What services are available when I am outside Community First's service area?

Basic benefits: Only emergency care services are covered outside the Community First’s network and/or service area, unless medically necessary covered services are not available through Community First's network of participating providers, or in the case of court-ordered dependent coverage.



If medically necessary covered services are not available through Community First's participating providers, Community First may allow, upon the request of a participating provider, an authorization to see a non-participating provider.



As a value-added service, we are pleased to offer members an Enhanced Travel Network to access urgent care while traveling. You and your covered family members have the option to see a First Health network provider in an urgent care situation while traveling outside of the Community First HMO service area. If you are in need of urgent care while you are traveling outside of the service area, you may contact First Health at (800) 226-5116 to locate a provider. 



Use of a First Health provider in an urgent care or emergency situation outside the service area may decrease your out of pocket costs, including balance billing. Balance billing means that the non-participating provider bills you for the portion of the charges not paid for by CFHP.


Q:

How do I file a complaint?

If you have a complaint, please call us at (210) 358-6262 or toll-free at (877) 698-7032. A Community First Member Services Representative can help you file a complaint. You may also send us a secure request on our website to tell us about your problem. Most of the time, we can help you right away or at the most within a few days.

You can file a complaint with the Texas Department of Insurance (TDI) at any time. 

You can contact TDI at:



Texas Department of Insurance

P.O. Box 149104
Austin, TX 78714-9104

Ph: 1-800-252-3439

Fax: (512) 475-1771

Web: www.tdi.state.tx.us
Email: ConsumerProtection@tdi.state.tx.us


Q:

What do I do if I am a new member?

Once you have chosen Community First, your next step is to select who will provide the majority of health care services to you and your covered dependents. Your primary care physician (PCP) will be the one you call when you need medical advice, when you are sick, and when you need preventive care such as immunizations. Each member may select his or her own PCP. You will select a PCP from Community First's extensive network of family or general practitioners, internists, and pediatricians. The selection of a PCP is crucial for immediate access to acute and preventive care. In the event that you do not choose a PCP when you enroll, Community First will select one for you and notify you by mail. Click here for a list of physicians and providers in the Community First network. You can also call our Member Services department at (210) 358-6262 or toll-free at (877) 698-7032 for assistance.


Q:

What do I do if I get a bill?

Call Member Services at (210) 358-6262 or toll-free at (877) 698-7032 for assistance. We can help you figure out what to do. Be sure to have a copy of the bill in front of you when you call.



Please note, some CFHP in-network facilities (hospitals, emergency clinics, outpatient clinics, ambulatory surgical centers, or other facility providing health care services) may have a facility-based physician or a facility-based health care practitioner, such as a radiologist, an anesthesiologist, a pathologist, an emergency department physician, or a neonatologist that is not included in the network. CFHP pays these providers under a fee schedule. These non-participating facility-based physicians and non-participating facility-based health care practitioners may balance bill the enrollee, which means receiving a bill from a provider for the reminder of the charges billed by the provider, for amounts not paid by the enrollee’s health benefit plan (Texas Insurance Code §1456.001,003).


Q:

What is my ERS health plan group number?

The ERS health plan group number is 0010180000. This information can also be found on your Community First Health Plans member ID card.


Q:

When can I expect my 1095-B form?

CFHP mailed 1095-B forms to participants in late February. If you have questions about your CFHP coverage, please call Member Services at (210) 358-6262 or toll free at (877) 698-7032.


Q:

When can I expect to receive my 1095 form to report insurance coverage for filing my tax return?

CFHP mailed 1095 forms to University Family Care Plan, ERS, and small group commercial members in late February. If you have questions about your CFHP coverage, please call Member Services at (210) 227-2347 or toll free at (800) 434-2347.