TOut-of-network providers who have been approved to render services to Healthfirst members will be reimbursed at the Healthfirst Standard Out-of-Network Fee Schedule applicable to the member’s Healthfirst plan
These fee schedules are established as a percentage of Medicaid or Medicare (depending upon the service and the member’s Healthfirst plan). These out-of-network fee schedules apply to the following plans
- Healthfirst Essential Plan
- Healthfirst Leaf and Leaf Premier Plans
- Healthfirst Pro, Pro Plus, and Total Plan
In these instances, the Explanation of Payment will indicate “OON RATE: SEE HEALTHFIRST.ORG”.