Question: Do You Need A Referral Keystone First?

What does keystone first dental cover?

Dental benefits for members over age 21, who are eligible for dental benefits, are eligible for: 1 dental exam and 1 cleaning, every 6 months.

Pulpotomies (removal of pulp) for pain relief.

Re-cementing of crowns (re-gluing the crown)..

Can I see a private doctor without a referral?

You can get private treatment from a consultant or specialist without being referred by your GP. But the British Medical Association (BMA) believes it’s best practice for patients to be referred for specialist treatment by their GP because they know your medical history and can advise you if a referral is necessary.

How do I get Keystone First Insurance?

Enroll Now Call 1-800-440-3989 (TTY users call 1-800-618-4225) for PA Enrollment Services. The HealthChoices enrollment specialists help people who are enrolled in the Medical Assistance program to choose a health plan. They have information about Keystone First and can answer your questions.

Does PA Medicaid cover eyeglasses?

Routine vision exams twice a year. $100 allowance toward eyeglasses (one frame and two lenses) or toward one pair of contact lenses and fitting per year* Glasses or contact lenses to treat cataracts or aphakia (medical condition) Specialist eye exam with referral from PCP.

Does Keystone first cover eyeglasses?

Keystone First does not cover prescription eyeglasses or prescription contact lenses for members 21 years of age and older, but there are special provisions for members with aphakia or cataracts. Call Member Services at 1-800-521-6860 for more information. *There may be co-pays for some eye care services.

Does Keystone first pay for gym memberships?

Great news! Your Keystone First Focus on Fitness gym program is now better than ever. No cost to you. No age limit.

Can you go to a specialist without a referral on Medicare?

Original Medicare benefits through Part A, hospital insurance and Part B, medical insurance, do not need their primary care physician to provide a referral in order to see a specialist. Complications with coverage can occur if you see a specialist who is not Medicare-approved or opts out of accepting Medicare payments.

Does Keystone first cover mental health?

The BH-MCO provides access to diagnostic, assessment, referral, and treatment services including but not limited to: Inpatient and outpatient psychiatric services. Inpatient and outpatient drug and alcohol services (detoxification and rehabilitation).

Does Keystone first cover tubal ligation reversal?

Infertility diagnosis and treatment services, including sterilization reversals and related office (medical or clinical) drugs, laboratory, radiological and diagnostic and surgical procedures are not covered.

Who is eligible for Keystone first?

You are 21 years of age or older and begin receiving Medicare Part D (Prescription Drug Coverage). You go to a state mental health hospital. You may also become eligible for Community HealthChoices.

Does Keystone first cover physical therapy?

Therapy services, after the first 24 combined visits, including outpatient physical, occupational, and speech therapy services; aquatic therapy; and cardiac and pulmonary rehabilitation services with a Keystone First network provider.

Do I need a referral for a specialist?

In order to see a specialist, you’ll need a referral from your primary care physician, except in an emergency. Without a referral, your insurance won’t cover the cost of your care.

Is Keystone First an HMO?

At Keystone First VIP Choice (HMO SNP), care is the heart of our work. We are a mission-based health plan that believes in treating you like the VIP you are.

Is Keystone first the same as Keystone Health Plan East?

The plan continued to grow, and in 1996, entered into a partnership with Keystone Health Plan East, the managed care entity of Independence Blue Cross, to form Keystone Mercy Health Plan. … Today, Keystone First serves more than 300,000 Medical Assistance recipients in the five-county Greater Philadelphia area.

Does Keystone Health Plan East require referrals?

Primary care visit to treat an injury or illness $10 copayment Not Covered ———–none———– Specialist visit $15 copayment Not Covered PCP referral required.

Can a doctor refuse to give you a referral?

A physician may refuse a referral for a variety of reasons but not if he or she has a preexisting duty to care for the patient.

What type of insurance is keystone first?

MedicaidKeystone First is Pennsylvania’s largest Medical Assistance (Medicaid) managed care health plan serving more than 400,000 Medical Assistance recipients in southeastern Pennsylvania including Bucks, Chester, Delaware, Montgomery, and Philadelphia counties.