Getting Care from Specialists
If you have a special health problem, your PCP may send you to a specialist. A specialist is a doctor trained to treat certain health problems. Specialists can include:
- Heart doctors (cardiologists).
- Skin doctors (dermatologists).
- Doctors for women’s issues (gynecologists).
- Doctors for pregnant women (obstetricians).
- Doctors for blood problems (hematologists).
- Foot doctors (podiatrists).
- Eye doctors (ophthalmologists).
- Cancer doctors (oncologists).
- Surgeons.
Your PCP can help you choose a specialist and make an appointment. You can get a list of Keystone First Community HealthChoices specialists clicking on Find a Provider, or by calling Participant Services.
If you would like to have more information about our Keystone First Community HealthChoices providers, call Participant Services. You can find out information like where they went to medical school, where they did their residency and if they are board certified.
Specialist office visits
Keystone First Community HealthChoices covers your visits to specialists in our network. There is no limit to how many times you may see the specialist. . There may be co-pays for your visits to some specialists. Please see the Participant copayment schedule (PDF).
If the specialist thinks you need surgery or other special treatment, you can ask to see another specialist. This is called a “second opinion.” If you want a second opinion, ask your PCP to refer you to another specialist in a different practice within the Keystone First Community HealthChoices network.
Out-of-network specialists
Visits to specialists who are not in the Keystone First Community HealthChoices network will need to have prior authorization (prior approval) from Keystone First CHC* . Your PCP has a special number to call to get prior authorization. Ask your PCP to help you.
If Keystone First CHC does not have at least 2 specialists to choose from who can treat your health problem, you have the right to ask to see a specialist who is not in the Keystone First CHC network*. Talk to your PCP about this.
If you also have Medicare coverage, you have the right to seek Medicare-covered services from the Medicare provider of your choice*. If you have questions about out-of-network specialists, please call Participant Services.
* Please note: it is important to see doctors who are in the Keystone First CHC network. The doctors you see and who order, refer or prescribe for you must be part of the Pennsylvania Medical Assistance program in order for the benefit or service to be paid for. You can use Find a Provider to find a provider in our network. Please also check with your doctor.