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Introducing our new Online Member Services!
Our members may now access their benefit information online through our secure website.
Access our enhanced online services by clicking "HERE"
or contact the Member Services Department at (775) 770-6060 or toll free at (800) 863 - 7515.
Saint Mary's HealthFirst HMO/POS is a proud recipient of the accreditation rating of Excellent from the National Committee for Quality Assurance (NCQA).
This accreditation rating recognizes that Saint Mary’s HealthFirst delivers high-quality care and service, and the Plan’s systems for consumer protection and quality improvement meet or exceed NCQA’s rigorous requirements. NCQA is an independent, not-for-profit organization that evaluates and rates managed care organizations and is widely recognized by employers, consumers and others as the most trusted, reliable source for information about the quality of the nation’s health care system. For more information on this achievement and what it means to health plan members, click here.
Introducing Saint Mary’s Medical Group
When you're seen by a physician who’s part of the Saint Mary’s Medical Group, you join the healthcare provider that’s ranked #1 in patient-care quality in the region. Our primary-care physicians offer ongoing, comprehensive healthcare for all ages.
Saint Mary’s Medical Group physicians provide care by appointment to manage your general healthcare needs and will:
- Diagnose and treat common health problems
- Refer and coordinate your medical care to a specialist or service
- Promote healthy lifestyles and disease prevention
- Manage your medications
Visit www.saintmarysmedicalgroup.com to learn more, or call 775-770-7100 to make an appointment.
Saint Mary's Health Plans welcomes you to our Members Web Page. We want to help our members to receive the
kind of care they want and need.
Our Members Section has several features.
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- If you are interested in literature about your HealthFirst or Point of Service benefits such as prescription drug coverage, dependent coverage, vision care services, Evidence of Coverage or Summary of Benefits, click here.
- If you are interested in which physicians, hospitals, laboratories, pharmacies, etc. participate in Saint Mary's Health Plans, click here.
- If you would like to know where HealthFirst members can go for urgent care services, click here
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- If you would like to know where HealthFirst members can go for emergency care services, click here
- If you are interested in pharmacy services such as which drugs are included in the preferred drug list or how to order prescriptions from home, click here.
- If you would like to view or download Saint Mary's HealthFirst Prior Authorization List, click here.
- If you would like to view or download Saint Mary's Health Choice Prior Authorization List, click here.
- If you have questions about how to request a new membership card, report a change of address, or the role of your primary care physician, please check our "FAQs" section by clicking here.
- If you have any questions, comments or suggestions about Saint Mary's Health Plans, please call our Member Services Representatives at 775-770-6060, Monday through Friday 8:00 a.m. to 5:00 p.m. or send us an email by clicking here.
General Information
You and your primary care physician.
If you are a member of our HMO or POS plan, you are required to choose a Primary Care Physician (PCP). With HealthFirst's comprehensive panel of physicians and specialists, choosing your PCP is easy. PCPs are general and family practitioners,
internists and pediatricians. For women, a secondary PCP may also be selected in the form of an OB/GYN or gynecologist who may be seen without a referral from the primary care physician. Your PCP is responsible for the following:
- Initial and primary care you receive, including the care you receive from specialists and other providers;
- Maintaining continuity of your care;
- Handling all associated paperwork;
- Initiating referrals to a specialist or other provider in accordance with HealthFirst's Evidence of Coverage (EOC).
Changing your PCP.
Should you need to change your primary care physician, contact Saint Mary's HealthFirst Member Services by:
- Phone: (775) 770-6060 or (800) 863-7515
- Fax: (775) 770-3820
- Email: memberservices@saintmarysreno.com
Obtaining care under your HMO plan.
To obtain care while insured with Saint Mary's HealthFirst, please take the following steps:
- Call your primary care physician (PCP) for an appointment.
- Tell the PCP's office staff you are with Saint Mary's HealthFirst.
- Upon arrival at your PCP's office, show your HealthFirst membership card.
- You are responsible for your office copayment at that time. The copayment amount is indicated on your HealthFirst membership card.
- Should you require a referral to a specialist or if you are in need of any hospital
or ancillary services, your PCP will refer you to those services and if necessary,
will request an authorization from HealthFirst.
To make sure appropriate healthcare is available when you're sick,
here are a few tips:
Getting appropriate healthcare when you're sick can be a problem. Here are a few tips
to help you be prepared before you need help:
- Make sure you are established with your primary care physician (PCP). It's easier to get medical advice or an appointment once your doctor knows you and has your medical records on hand.
- Ask what your doctor's office policy is concerning unexpectedly sick patients. Does the office keep some appointments for patients who need to be seen urgently? How soon can you speak with a medical professional when you need questions answered?
- When you or someone in your family is ill, call your doctor's office as soon as possible. Waiting until late in the day or until the end of the week can make it difficult to get an appointment if you need to be seen.
- Locate an urgent care facility close to you that is covered by your insurance (refer to your HealthFirst Provider Directory) and keep the address, phone number and days and hours of operation handy.
- Know the location of at least one pharmacy on your health insurance plan (refer to your HealthFirst Provider Directory) that is open 24 hours a day so you can have prescriptions filled anytime.
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