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Member Frequently Asked Questions

General
Q:

Who makes up the Member Advisory Group?

Our current membership on the Member Advisory Group (MEAB) is made up of members and parents, who have children as members of this health plan, they work in social services, schools, and community agencies and provide valuable insight to the health plan. Several of them have been with CFHP for many years, they live in various parts of the city. They provide a vehicle for obtaining insight into the perceptions and expectations of health plan consumers, and to enable the health plan to tailor policies and operations to best meet the needs of the membership. Since members are key in providing input on issues related to health plan education, health plan services, and to serve in designated committees within Community First Health Plan, MEAB is an excellent way of facilitating these endeavors. If you are interested in learning about how you can participate, call Member Services at 1-800-434-2347. 

STAR Kids: 1-855-607-7827

STAR Kids Member Advisory Committee

Community First Health Plans is seeking STAR Kids members or their representatives to participate on the new STAR Kids Member Advisory Committee (SK MAC). The Committee is dedicated to provide an opportunity for STAR Kids families to share insights about their perceptions and expectations of the health plan.

The goal of the new Advisory Committee is to provide recommendations and/or input to allow the health plan to make any changes to the operations and/or educational opportunities that best meet the needs of STAR Kid membership. For questions or to express your interest in participating in the STAR Kids Member Advisory Committee please contact:

Mary Helen Gonzalez
Executive Director, Member Services Department
Office: (210) 358-6062
Email: mhgonzalez@cfhp.com


Q:

How can I receive member materials in a different format other than print?

If you need any member materials in a different format, for example large print, Braille, audio, etc, please contact Member Services at 210-227-2347.


Q:

What is Member Portal?

Click on the Member Portal link on our homepage to register. This is a secure website. You can request an ID card, ask to change your PCP, file a complaint, or ask a question. If you are more comfortable talking to a Member Services Advocate, just call. Our phone number is (210) 358-6300. Or you can call us toll-free at 1-800-434-2347. We are here to help you!


Q:

Who is my Primary Care Provider (PCP)?

Your Primary Care Provider (PCP) is your own doctor or clinic who will provide or arrange your medical care. You can look up your PCP or any specialist in the Community First network on this website using the "Find a Provider" link.


Q:

How do I change my Primary Care Provider (PCP)?

Call Member Services at (210) 358-6262 or toll-free at (877) 698-7032 and a representative can help you designate a new primary care physician. You can also request to change your primary care physician on our website by submitting a secure request through our secure member portal. Click on "contact us," then "send a secure request to Member Services."


Q:

What is Community First's Service Area?

Community First's service area includes all of Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina and Wilson counties.


Q:

What services are available when I am outside Community First's service area?

The only services covered outside Community First’s service area are emergency room visits (E.R.). If you want to receive services outside the service area, with the exception of E.R. visits, a prior authorization will be required before the visit. Also, if medically necessary covered services are not available through Community First’s participating providers, Community First may allow you to see non-participating provider with a prior authorization request from the provider of your choice.


Q:

What do I do if I am a new member?

Once you have chosen Community First, your next step is to select who will provide the majority of health care services to you. Your primary care physician (PCP) will be the one you call when you need medical advice, when you are sick, and when you need preventive care such as immunizations. Each member may select his or her own PCP. You will select a PCP from Community First's extensive network of family or general practitioners and pediatricians. The selection of a PCP is crucial for immediate access to acute and preventive care. Click here for a list of physicians and providers in the Community First network. You can also call our Member Services department at (210) 358-6262 or toll-free at (877) 698-7032 for assistance.


Q:

When can I receive/replace my Member ID card?

CFHP makes every effort to provide new Members with ID cards as quickly as possible once enrollment information is transmitted. However, during the time of enrollment processing, Members and providers may verify eligibility through CFHP’s secure portal. Member information is updated daily.

If you need to request a replacement or additional ID card, you may do so through our secure web portal. You may also call Member Services at (210) 227-2347 or toll-free at 1-800-434-2347.


Q:

Is a referral or authorization required to see a specialist?

Community First does not require a referral to see a specialist. Some specialists may require a referral from your PCP in order to see you. Additionally, some services require a pre-authorization from Community First before you receive services. Your PCP will take care of this request for you. You can call Member Services to find out if a certain service requires authorization.



Some services may require a referral:

  • Behavioral health services
  • OB/GYN services
  • Vision exams from an optometrist


Call Member Services if you need assistance finding a provider or to help you schedule an appointment at (210) 227-2347 or toll-free at 1-800-434-2347.


Q:

What emergency, after hours, and urgent care services are available?

Emergency Care:
In a medical emergency, call 9-1-1 or go to the nearest emergency room. Call your primary care physician as soon as possible after you get care. Your doctor can help you arrange follow-up care.

Emergency medical condition means: a medical condition manifesting itself by acute symptoms of recent onset and sufficient severity (including severe pain), such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical care could result in:

  1. Placing the patient's health in serious jeopardy
  2. Serious impairment to bodily functions
  3. Serious dysfunction of any bodily organ or part
  4. Serious disfigurement
  5. In the case of a pregnant woman, serious jeopardy to the health of a woman or her unborn child.

Urgent Care:
Urgent medical care is when you are sick or hurt, and need help within 24 hours to keep from getting worse. You should call your Primary Care Physician, who will direct you based on your symptoms. You may also call Community First. We have a nurse advice line, available 24 hours, 7 days a week. They can give you guidance based on your situation.

After Hours Care:
Illnesses and injuries sometimes occur after normal office hours. If you get sick or injured after hours, you should call your primary care provider. He or she has made arrangements to have their calls answered 24 hours a day, 7 days a week. You can also call Community First Member Services. We have nurses who can help you 24 hours a day, 7 days a week. The nurse might refer you to an urgent care center, the hospital emergency room, or to a doctor who is open after routine office hours. The nurse might also give you home advice.


Q:

What do I do if I get a bill?

Call Member Services at (210) 358-6262 or toll-free at (877) 698-7032 for assistance. We can help you figure out what to do. Be sure to have a copy of the bill in front of you when you call.



Please note, some CFHP in-network facilities (hospitals, emergency clinics, outpatient clinics, ambulatory surgical centers, or other facility providing health care services) may have a facility-based physician or a facility-based health care practitioner, such as a radiologist, an anesthesiologist, a pathologist, an emergency department physician, or a neonatologist that is not included in the network. CFHP pays these providers under a fee schedule. These non-participating facility-based physicians and non-participating facility-based health care practitioners may balance bill the enrollee, which means receiving a bill from a provider for the reminder of the charges billed by the provider, for amounts not paid by the enrollee’s health benefit plan (Texas Insurance Code §1456.001,003).


Q:

How can I contact interpreter services?

Please call member services at (210) 227-2347 to contact interpreter services. 


Q:

What is the name of the pharmacy vendor (for prescription benefits)?

Your health plan includes a 3-tier prescription drug benefit, which is administered by Community First and our Pharmacy Benefit Manager (PBM), Navitus Health Solutions. Please click here for more information about your pharmacy benefits.


STAR Kids/STAR Medicaid
Q:

How can I choose a Primary Care Provider (PCP)?

You can go to Find a Provider page and select your plan to choose a PCP. After your selection, you must call member services at (210) 227-2347 to update your PCP. 

Note: Please remember to have the name of your new PCP accessible when contacting member services.

For any dental questions, please contact your dental plan: 

DentaQuest - 1-800-516-0165

MCNA - 1-855-691-6262


Q:

How can I get a breast pump?

Breast pumps are a covered benefit, which covers a manual or non- hospital grade electric breast pump. In order to get a breast pump, you will have to get a prescription from your physician and take it to a participating medical supply provider. If you need help finding a participating medical supply provider, click here.


Q:

What extra benefits does a member of Community First get?

As a STAR member, you have access to the following extra STAR benefits including:

  • 24-Hour Nurse Advice Line
  • Bus tokens for doctor visits and health education classes
  • Extra vision benefits
  • A prescription discount card your whole family can use
  • Free sports and school physicals
  • Weight management program
  • Smoking cessation program
  • Emergency advice kit
  • Asthma kit
  • Personal visits for pregnant women
  • Member gift card programs


Call us at 1-800-434-2347 to learn more about these and other benefits.


Q:

How can I request a Fair Hearing?

If a member disagrees with Community First Health Plans (CFHP) decision, you have the right to ask for a Medicaid fair hearing. Members can contact us at our toll free number STAR Medicaid: 1-800-434-2347; STAR Kids 1-855-607-7827, or send a letter to the health plan at 12238 Silicon Drive, Suite 100, San Antonio, TX 78249 to ask for a State Fair Hearing. A State Fair Hearing can be requested at any time. It can be during or after CFHP’s appeals process. After contacting us, a package of information will be mailed out letting you know the date, time and location of the hearing. Members may call STAR Medicaid: 1-800-434-2347 or STAR Kids: 1-855-607-7827 to get more information regarding the process or status questions of Fair Hearing Process.

Fair Hearing Document PDF


Q:

Who do I contact if I have questions regarding my vision benefits?

Please contact member services regarding your vision eligibility and benefits at 210-227-2347. Or follow this link if you are looking for your provider contracted with your vision plan. 


Q:

Who do I contact if I have questions about my dental benefits?

Please contact your dental plan:

DentaQuest - 1-800-516-0165

MCNA - 1-855-691-6262

If you have any additional questions regarding your eligibility, please contact member services at (210) 227- 2347.


CHIP
Q:

How can I choose a Primary Care Provider (PCP)?

You can go to Find a Provider page and select your plan to choose a PCP. After your selection, you must call member services at (210) 227-2347 to update your PCP. 

Note: Please remember to have the name of your new PCP accessible when contacting member services.

For any dental questions, please contact your dental plan: 

DentaQuest - 1-800-516-0165

MCNA - 1-855-691-6262


Q:

What extra benefits does a member of Community First get?

As a CHIP member, you have access to the following extra CHIP benefits including:

  • 24-Hour Nurse Advice Line
  • Bus tokens for doctor visits and health education classes
  • Extra vision benefits
  • A prescription discount card your whole family can use
  • Free sports and school physicals
  • Weight management program
  • Smoking cessation program
  • Emergency advice kit
  • Asthma kit
  • Member gift card programs


Call us at 1-800-434-2347 to learn more about these and other benefits.


Q:

Who do I contact if I have questions regarding my vision benefits?

Please contact member services regarding your vision eligibility and benefits at 210-227-2347. Or follow this link if you are looking for your provider contracted with your vision plan. 


Q:

Who do I contact if I have questions about my dental benefits?

Please contact your dental plan:

DentaQuest - 1-800-516-0165

MCNA - 1-855-691-6262

If you have any additional questions regarding your eligibility, please contact member services at (210) 227- 2347.


CHIP Perinatal Program
Q:

Who is the Prenatal Care Provider?

Your prenatal care network provider is an OB/GYN of your choice. Please keep in mind that this provider has to be contacted with CFHP for services to be covered under the health plan. Click here to see a list of the prenatal care providers and the hospitals where you will deliver you baby.

You do not need a referral to call the doctor or clinic of your choice.


Q:

What extra benefits does a member of Community First get?

As a CHIP Perinatal member, you have access to the following extra CHIP Perinatal benefits including:

  • 24-Hour Nurse Advice Line
  • Bus tokens for doctor visits and health education classes
  • A prescription discount card your whole family can use
  • Free flu shots for CHIP Perinatal members
  • Personal visits for pregnant women

Call us at 1-800-434-2347 to learn more about these and other benefits.


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