Service Authorization—HomeFirst’s review to determine whether health care services that have been provided, are being provided or are requested for an enrollee are medically necessary.
Special Needs Plan (SNP)—An SNP is a specialized Medicare health plan designed to offer coverage to individuals with specialized needs. These individuals are defined by three categories: 1) institutionalized individuals; 2) dual eligibles; or 3) individuals with severe or disabling chronic conditions.
Specialist—A doctor who provides health care services for a specific disease or part of the body. Examples include oncologists (care for cancer patients), cardiologists (care for the heart) and orthopedists (care for bones).
Urgent Care—Urgent care is needed when your medical condition does not place you in serious jeopardy but could get worse and care is immediately needed. If you are in the Elderplan service area and need urgent care, call your PCP.
Urgent Care (Applicable to Homefirst Users)—Definition per HF Member Handbook: An urgent care need is an illness or medical problem that needs attention by your physician or other health care provider before your next routine office visit.
Usually, urgent care is provided when you are outside the Elderplan service area. You may visit a walk-in clinic or regular doctor’s office for urgent care. You do not pay the co-payment if you are admitted to the hospital within one day for the same condition.