FirstHealth

If you or a loved one is seeking mental health treatment, understanding how FirstHealth Network functions can help you access the care you need while managing costs. FirstHealth Network is one of the largest preferred provider organization (PPO) networks in the United States. It's important to note that FirstHealth Network is not an insurance company itself, but rather a network of healthcare providers that works with various insurance plans. FirstHealth Group Corporation is a wholly owned subsidiary of Aetna Inc., which is now part of CVS Health.

The FirstHealth Network includes more than 6,400 hospitals, 151,000 medical facilities, and over 1.2 million professional healthcare providers nationwide. This extensive network means that approximately 95% of Americans live within 20 miles of a FirstHealth Network provider. As a PPO network, FirstHealth allows members to access services from in-network providers without requiring a referral from a primary care physician, offering flexibility when seeking mental health care.

Since FirstHealth Network is a provider network and not an insurance company, your specific benefits for mental health services depend on your insurance plan that utilizes the FirstHealth Network. Under the Affordable Care Act (ACA), mental health services are considered essential health benefits, meaning all ACA-compliant health plans must provide some level of coverage for mental health and substance use disorder treatment.

What Mental Health Services Can Be Accessed Through FirstHealth Network?

Through FirstHealth Network, members can access a wide range of mental health services, depending on their specific insurance plan's coverage. The network includes various mental health professionals and facilities that provide both outpatient and inpatient services for behavioral health conditions.

Types of Mental Health Services Available

When using providers within the FirstHealth Network, you may be able to access various levels of care, from standard outpatient services to more intensive treatment options. Mental health services commonly available through network providers include regular therapy sessions with licensed mental health professionals such as psychologists, psychiatrists, licensed counselors, and social workers. These professionals can provide individualized treatment for various mental health concerns through regular appointments.

For medication management, psychiatrists and other appropriate medical professionals within the network can prescribe and monitor medications for mental health conditions. Some plans may also cover more structured treatment options for those requiring more intensive support, such as Intensive Outpatient Programs (IOPs) and Partial Hospitalization Programs (PHPs), which offer comprehensive care while still allowing patients to maintain some of their daily routines. In cases requiring round-the-clock supervision, inpatient or residential treatment at specialized mental health facilities may be covered for acute conditions.

The FirstHealth Network includes providers who treat a wide range of mental health conditions, including:

• Depression and anxiety disorders

• Bipolar disorder and mood disorders

• Post-traumatic stress disorder (PTSD)

• Obsessive-compulsive disorder (OCD)

• Substance use disorders

• Attention-deficit/hyperactivity disorder (ADHD)

• Serious mental illnesses like schizophrenia

Navigating Insurance Coverage Through FirstHealth Network

Understanding how to verify your coverage and navigate the payment process is essential for accessing mental health care through the FirstHealth Network without unexpected financial burdens.

Verifying Your Mental Health Benefits

To confirm your specific mental health benefits for services within the FirstHealth Network, you should contact your insurance provider directly using the customer service number on your insurance card. When calling, be sure to specify that you're inquiring about mental health services with providers in the FirstHealth Network.

Your insurance provider can explain what behavioral health services are covered, any limitations or restrictions that may apply, and your financial responsibility for these services. Since FirstHealth is a PPO network, many insurance plans categorize providers as "primary network," "secondary network," or "non-network negotiation," with the most coverage typically provided for primary network providers.

During the verification process, be prepared to provide your member ID number, your date of birth, and information about the type of mental health services you're seeking. It's also important to ask specifically about any preauthorization requirements, coverage limitations, and your financial responsibility for services.

According to FirstHealth Network's provider directory information, "You may incur additional costs if you use out-of-network providers. Authorizations and referrals for care may be required to access some providers. If you have questions about authorizations, referrals or your health plan benefits, you can call the customer service number on your member ID card."

Understanding Authorization Requirements

Many insurance plans require prior authorization for certain mental health services, particularly for intensive levels of care. This is a process where your provider must obtain approval from your insurance company before services are delivered to ensure coverage.

Services that commonly require prior authorization include:

• Inpatient psychiatric hospitalizations

• Residential treatment programs

• Partial hospitalization programs (PHPs)

• Intensive outpatient programs (IOPs)

• Specialized treatments or procedures

Standard outpatient therapy sessions with in-network providers generally do not require prior authorization, though there may be limits on the number of sessions covered annually before additional authorization is needed.

The authorization process typically begins with your provider submitting a request to your insurance company with clinical information justifying the need for the recommended treatment. The insurance company reviews this information to determine whether the service meets their criteria for medical necessity, based on clinical guidelines and the specific nature of your condition. A decision is then made to approve, modify, or deny the service request, and both you and your provider receive notification of the decision.

Financial Aspects of Using FirstHealth Network

As with any healthcare service, understanding the financial aspects of mental health care through FirstHealth Network is important for planning your treatment.

Your financial responsibility for mental health services will depend on your specific insurance plan but typically includes your deductible (the amount you pay before insurance begins to pay), copayments (fixed amounts paid per service), coinsurance (percentage of costs you pay after meeting your deductible), and your out-of-pocket maximum (the most you'll pay in a year before insurance covers 100%).

For in-network providers participating in FirstHealth Network, costs are based on negotiated rates. Using in-network providers typically results in significantly lower out-of-pocket costs compared to out-of-network providers. However, it's important to note that FirstHealth Network itself does not process claims or make payments. As stated on their provider directory website, "If you are seeking benefit, eligibility, pre-authorization, pre-certification, claim payment information or copies of the Explanation of Benefit (EOB), please contact the payer listed on the ID card. First Health Group Corp is not an insurance company and we do not sell insurance or pay finalized claims."

Finding Providers in the FirstHealth Network

The FirstHealth Network makes it easy to find in-network providers for mental health services. You can search for providers through your insurance company's online portal or by using the FirstHealth provider directory at providerlocator.firsthealth.com.

When searching for mental health providers, you can filter results based on specialty, location, and other criteria to find professionals who meet your specific needs. It's always a good idea to call providers directly to confirm they're still in the FirstHealth Network and are accepting new patients before scheduling an appointment.

If you have difficulty finding an appropriate provider in the network, FirstHealth's website notes, "If an appropriate provider cannot be found within the directory, please contact your insurer/carrier to discuss arrangement of care from outside of the network."

Next Steps for Accessing Mental Health Care

When you're ready to find mental health care through the FirstHealth Network, follow these steps:

1. Contact your insurance provider to verify your specific benefits for mental health services through the FirstHealth Network

2. Use the FirstHealth provider directory to search for in-network mental health professionals in your area

3. Call potential providers to confirm they accept your insurance and are taking new patients

4. Work with your chosen provider to obtain any required authorizations before beginning treatment

5. Prepare for your first appointment by gathering your insurance information and medical history

Remember that seeking help for mental health concerns is a sign of strength, not weakness. With the extensive FirstHealth Network, you have access to quality mental health care providers who can help you on your journey to better mental health.

Ready to find treatment? Browse our directory of mental health facilities that work with FirstHealth Network in your area.

References

[1] Health Plan Alliance. "First Health Network - HPA." https://www.healthplanalliance.org/assnfe/cv.asp?ID=601683

[2] U.S. Department of Health & Human Services. "Mental Health and Substance Use Insurance Help." https://www.mentalhealth.gov/get-help/health-insurance

[3] First Health Group Corp. "Provider Directory." https://providerlocator.firsthealth.com/LocateProvider/SelectNetworkType