Novel Coronavirus (COVID-19)
Physician/Provider Notice
Find information about COVID-19 coding guidelines, claims submission procedures, and reduced prior authorization requirements on the provider section of our website.

FirstCare Health Plans – Here With You Through COVID-19

FirstCare Health Plans and Baylor Scott & White Health are actively monitoring COVID-19 developments and are working together to ensure members get the care and coverage they need, when they need it most.  You can expect claims processing, customer service by phone and member portal, and other operations to continue as usual.

To protect our members and also our health plan employees, we are temporarily suspending in-person visits to our health plan.  We hope to welcome you back to our offices very soon.

We have more information on COVID-19 and how to keep your loved ones safe at BSWHealth.com.

COVID-19 Vaccine Update (updated December 2020)

The U.S. Food and Drug Administration (FDA) recently issued Emergency Use Authorizations for COVID-19 vaccines by Pfizer and Moderna. We want to answer a few of your questions about this exciting new development in the fight against COVID-19.

When will vaccines be available?
Vaccines will be released in phases determined by the Texas Department of State Health Services, based on guidance from the Centers for Disease Control and Prevention (CDC). At this time, all Texas healthcare organizations that receive an allocation of the COVID-19 vaccine must distribute it based on this guidance.

What will the COVID-19 vaccine cost?
The COVID-19 vaccine will be available to health plan members at zero out-of-pocket cost.

Benefit Updates

The following updates apply to fully insured Commercial Group and Individual policies, as well as Medicare plan members (except where noted). Members of self-insured groups should contact their Human Resources Department regarding coverage.

Costs for COVID-19 Testing and Treatment
Effective March 6, 2020, and until further notice, FirstCare Health Plans is waiving all member cost-sharing for care related to COVID-19, which includes testing, telehealth services, outpatient office visits, and inpatient hospital stays.

All telehealth medical care is also covered at a $0 copayment, whether the service is provided through the member’s in-network physician, or through MDLIVE (more information provided below).

Prescription Drug Refills and Rx Prior Authorizations
In conjunction with our pharmacy benefit manager, FirstCare Health Plans is amending its prescription drug policies to ensure an uninterrupted supply of medication during the COVID-19 threat.
  • Early Refills. You may obtain an early refill of your prescription medications if you have refills remaining on file at a participating retail or mail-order pharmacy. The refill obtained will stay consistent with the standard days’ supply previously filled as allowed by your plan (e.g., 30- or 90-day supply).
  • Extended Authorizations. We are extending prescription drug approvals (prior authorizations) for most medications for an additional 90 days for Commercial* members whose authorizations expire on or before September 30, 2020.
*Commercial plans subject to Texas Department of Insurance requirements

Ways to Slow the Spread

As the number of COVID-19 cases and hospitalizations in Texas rise, we can take three simple actions to slow the spread:
  1. Wear a mask to protect yourself and others.
  2. Stay at least 6 feet (about 2 arm lengths) from others who don’t live with you, and avoid crowds.
  3. Wash your hands with soap and water for 20 seconds or use hand sanitizer with at least 60% alcohol.
COVID-19 is not the only virus we need to be mindful of this winter. If you haven’t already, it’s not too late to get a seasonal flu shot. We cover flu vaccinations for members at no charge at in-network pharmacies, walk-in clinics and your doctor’s office.

What to Do if You're Sick

If you feel sick with fever, cough, or have difficulty breathing and have traveled to high-risk locations or were in close contact with someone with COVID-19 in the 14 days before you began to feel sick, seek medical care.

Option 1: Stay home and visit a doctor virtually.
FirstCare Health Plans has teamed up with MDLIVE to provide access to board-certified doctors 24 hours a day, seven days a week.

To visit with a doctor:
  • Log into your member portal;
  • Download the MDLIVE mobile app; or
  • Call and speak to an MDLIVE representative at 1-800-718-5082
After your visit, prescriptions (if needed) will be sent immediately to your preferred pharmacy.
 
Option 2:  Find a doctor, clinic or hospital near you. 
When you schedule your visit, share your concerns about your COVID-19 symptoms or exposure. Your doctor’s office, clinic or hospital will have instructions for your visit.
 
Option 3:  If you are experiencing a medical emergency, call 911.
Notify the operator if you have COVID-19 or need to be seen for COVID-19 symptoms. If available, put on a face mask before the ambulance arrives.

We're Here to Help

FirstCare Health Plans is dedicated to providing ongoing access to quality healthcare services for members impacted by public health emergencies. We will follow federal and state guidance while working with hospitals, drug stores and other providers to ensure our members get the care and medications they need.

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