Providers Directory
Providers Directory
The General Network Provider Directory will provide you a list of contracted providers throughout the Island. This directory includes Primary Medical Groups, Primary Care Physicians, specialists, behavioral health providers, dentists, hospitals, laboratories, pharmacies, amongst others.
The General Network Provider Directory provides the following information about the physicians:
- Medical Specialty
- Name
- Address
- Telephone numbers
- Office days and business hours
If you need a copy of the General Provider Directory, please feel free to contact First Medical Customer Service at 1-844-347-7800; TTY/TDD users should call 1-844-347-7805, Monday through Friday from 7:00 a.m. to 7:00 p.m. First Medical will send you free of charge, the General Provider Directory in five (5) business days from the date of your request.
Your Primary Care Physician and other doctors
When you sign up with First Medical, you must choose a doctor or Primary Care Physician (PCP). This is the person you will turn to for most health services. This includes exams, treatment for colds and flu, health concerns, and routine exams. Your PCP can find and treat health problems early. He or she will have your medical records. Your PCP can see your whole health care picture. Your PCP will follow up on all the care you receive.
There are different types of doctors who are PCP’s, like:
- General Practitioners
- Family Physicians
- Pediatricians
- Gynecologists/Obstetricians
- Internists
You must choose a PCP for each insured member in your family. Your family members can have different PCP’s.
If you are a woman over the age of twelve (12) years, you can also choose a gynecologist to be your PCP. If you are pregnant, your PCP could be your obstetrician during your pregnancy. When your pregnancy ends you will go back to your regular doctor, but your gynecologist will still take care of your gynecological needs. You may choose a pediatrician or a family physician for your newborn or one will be chosen for you.
To choose your PCP, call First Medical at 1-844-347-7800; TTY/TDD users should call 1-844-347-7805. If you do not choose one, then one will be chosen for you.
A Primary Medical Group is a group of doctors who help coordinate your healthcare services and work with First Medical to ensure you receive the care you need. Your Vital Plan Card displays the name of your PCP and your Primary Medical Group number.
How can I see my PCP?
If you need an appointment, call your PCP. It is free to make appointments with them. It is important that you keep your appointments with your PCP. If you cannot make it for any reason, call the PCP’s office right away to let them know.
If your PCP is new for you, you should get to know him/her. Call to get an appointment as soon as you can. This is even more important if you’ve been getting care or treatment from a different doctor. We want to make sure that you keep getting the care you need. If you feel well, you should call your PCP to schedule a routine examination.
Before you go to your first appointment:
- Ask your past doctor to give you your medical records. This is free of charges. Bring your medical records to your new PCP at your first visit. It will help your new PCP learn about your health.
- Call your PCP to coordinate your appointment.
- Have your Vital Plan Card ready when you call.
- Say that you are a Vital Plan beneficiary and provide your identification number or MPI.
- Write down your appointment date and time. If you’re a new patient, the provider may ask you to come early. Write down the time they ask you to be there.
- Make a list of questions you want to ask your doctor. List any health problems you have.
- If you need a ride to the appointment and have no other way to get there, call First Medical or your local Municipality. They can help you get a ride.
On the day of your appointment:
- Bring a list of all your medicines and your questions with you so your doctor will know how to help you.
- Be on time for your visit. If you cannot keep your appointment, call your PCP to get a new appointment.
- Take your Vital Plan card with you. Your PCP may make a copy of it.
What if it’s an emergency and I need care after my PCP’s office closes?
Most PCP’s have regular office hours. First Medical’s Provider Directory will tell you when your doctors’ offices are open. Most Primary Medical Groups also have clinics that are open late. But, you can call First Medical Health Plan’s Medical Advise Line anytime.
You can get emergency health care any time you need it. Always carry your Vital Plan card with you. In case of an emergency, doctors will know you have Vital Plan.
If you call the First Medical Health Plan Medical Advice Line before you go to the Emergency Room, you will not have to pay copayments.
The number for First Medical’s Medical Counseling Line is 1-844-347-7801. TTY/TDD users should call 1-844-347-7804.
Emergencies are times when there could be serious danger or damage to your health if you don’t get medical care right away.
Emergencies can be:
- Shortness of breath, not able to talk
- A deep cut, broken bone, or a burn
- Bleeding that cannot be stopped
- Severe chest pain that does not go away
- Severe and consistent stomach pain
- Seizures that cause someone to pass out
- Not able to move your legs or arms
- A person who will not wake up
- Drug overdose
These are usually not emergencies:
- Sore throat
- Cold or flu
- Lower back pain
- Earache
- Stomachache
- Small, superficial, cuts
- Bruise
- Headache, unless it is very bad and like you’ve never had before
- Arthritis
If you think you have an emergency, go to the nearest hospital Emergency Room (ER). If you can’t get to the ER, call 9-1-1.
If you need emergency care, you do not have to get authorization from anyone before you get medical care.
If you are not sure if it’s an emergency, call your PCP. You can call First Medical Health Plan’s Medical Advice Line at any time. Your PCP can help you get emergency care if you need it.
Can I change my PCP?
Yes, you can change your PCP at least once a year. There are other reasons why you may need to change your PCP. For example, you may want to see one whose office is closer to you. To change your PCP you must call First Medical to corroborate whether the change may be performed.
You can also change to a new Primary Medical Group if the PCP you want to see is in a different Primary Medical Group.
Most of the time, after the first ninety (90) days of enrolling with the insurer under the Vital Plan, you can change your Primary Medical Group at any time for certain reasons, such as:
- Your PCP cannot give you the care or treatment you need because of ethical (moral) or religious reasons.
- Your PCP cannot offer all the services that you need at the same time. Failure to receive all services as ordered may represent an unnecessary risk for you.
- You receive poor quality care.
- You cannot access the services you need.
- Your PCP does not have the experience to take care of your healthcare needs.
For orientation and to make the change, call First Medical at 1-844-347-7800; TTY/TDD users should call 1-844-347-7805.
Another reason why your PCP or Primary Medical Group could change is if your PCP or Primary Medical Group stops working with First Medical. If this happens, First Medical will send you a letter letting you know your new PCP or Primary Medical Group. If you want to change your PCP or Primary Medical Group, call First Medical at 1-844-347-7800; TTY/TDD users should call 1-844-347-7805.
What happens after I ask for the change?
Once you make the change with First Medical, it will take some time for the change to be effective. If you make the change in the first five (5) days of a month, it will be effective in the next month. For example, if you make the change on January 5, it will be effective on February 1. But if you make the change after the first five (5) days of the month, it will be effective the month after next. For example, if you make the change on January 6, it will be effective March 1.
You should continue seeing your previous PCP until the change is effective. You cannot start seeing your new PCP until the new change is effective.
What about other doctors or providers I need to see?
Besides your PCP, you may also need to see other doctors and health care providers, like specialists. A specialist is a doctor who provides health services for a specific illness or part of the body. One type of specialist is a cardiologist, who is a physician that treats the heart. Another kind of specialist is an oncologist, who treats cancer. There are many kinds of specialists.
Besides specialists, you may also need to go to other healthcare professionals and healthcare facilities to get care, like laboratories, x-ray facilities, or hospitals. The doctors, other health care professionals and service facilities that work with First Medical and your Primary Medical Group are called the Preferred Provider Network.
The other doctors, other health care professionals and service facilities that work with First Medical are called the General Network. When you enroll with First Medical, they will mail you a Provider Directory containing information about the Preferred Provider Network and the General Network. You can find these lists in the Provider Directory section. Your Primary Medical Group and the First Medical Service Offices can also provide you with a copy of the lists.
For more information about how the Vital Plan works if you have Medicare, look at Part 8 of your Beneficiary Manual.
Preferred Provider Network
There are benefits to seeing the doctors, other health care professionals and service facilities in the Preferred Provider Network.
- You can visit any of the doctors and service facilities in the Preferred Provider Network for free.
- If you visit the doctors, healthcare professionals and service facilities in your Preferred Provider Network, you don’t need to go to your PCP first to get a referral.
- If you get any of the following services within the Preferred Provider Network, you don’t need your PCP to sign off:
- Prescription medicine
- Laboratory tests
- X-rays
To get more information about your Preferred Provider Network, you can:
- Call First Medical at 1-844-347-7800; TTY/TDD users should call 1-844-347-7805.
- Call the Vital Plan Call Center at 1-800-981-2737; TTY users should call (787) 474-3389.
- Go to First Medical Service Offices.
- Call your Primary Medical Group.
General Network
The General Network is the health care professionals and services facilities that work with First Medical and that support the Primary Medical Groups. If the doctor or provider you need to see isn’t in your Preferred Provider Network, they might be in First Medical General Network. You can see any doctor or provider in First Medical General Network as long as you go to your PCP first to get a referral. If you need a referral, your PCP must give you one during your visit or within twenty-four (24) hours after you ask for one.
Your PCP will coordinate your visits to doctors or providers in the General Network.
You might need to pay money for these visits. Look at Part 4 of your Beneficiary Manual for more information about payments.
If you get any of the following by a provider in the General Network, your PCP will have to sign off:
- Prescription medicine
- Laboratory tests
- X-rays
Out-of-Network
A doctor or other provider who does not work with First Medical is called an Out-of-Network provider. If you need to see a doctor or another provider who is outside of the network, you must obtain a referral from your PCP. You can receive care at an Out-of-Network community health clinic.
If you feel that First Medical or your doctors are not following these rules, you can call First Medical at 1-844-347-7800; TTY/TDD users should call 1-844-347-7805 and tell them that you need to make a complaint. You can also call the Patient Advocate Office at 1-800-981-0031 or ASES at 1-800-981-2737.
Help with getting to your health care visits
If you don’t have a way to get to your health care visits, First Medical and your Municipality can help with transportation. Each Municipality has some ways to help you get to your visits. Call First Medical at 1-844-347-7800; TTY/TDD users should call 1-844-347-7805, or call your local Municipality for help.
First Medical and some providers also offers transportation for some members through care management. If you need the help of a Care Manager and you do not have one, call First Medical at 1-844-347-7800; TTY/TDD users should call 1-844-347-7805. Part 5 of your Enrollee Handbook has more information on care management.
