First Choice Sixty-Five

First Choice Sixty-Five is a Medicare Advantage plan offered by Regence BCBSO to individuals as an alternative to Medicare Parts A and B and Medicare supplement plans. The First Choice Sixty-Five service area includes Columbia, Clackamas, Marion, Multnomah, Polk and Washington counties in Oregon and Clark County in Washington. It provides all the benefits available from Medicare, plus additional benefits.

A health maintenance organization (HMO) plan is structured to manage the health care provided to its members. All physicians, other professional providers, health care facilities and their office staff need to be aware of the tools used to manage health care services in order to work successfully within HMO plans. Important features of HMOs include:

• Primary care physicians (PCPs) are managers of members' health care.
• Referrals are required from the PCP to participating specialty physicians, other referral providers or health care facilities.
• Members may receive some services without a referral from their PCP. Examples of these are annual women's gynecology exam, obstetrical care, diabetic education, and influenza and pneumococcal vaccinations.
• All health care received from a nonparticipating physician or other professional provider must be approved in advance.
• Preauthorization is required for specific services identified on the Preauthorization List.
• Successful management of the members' care by the PCP may result in risk pool return.
• At the time a member enrolls in one of our managed care plans, they must select a PCP from the PCP directory.

The PCP's responsibilities include:

• Providing routine health care, including preventive health exams and treatment for illness and injury.
  
• Coordinating health care with participating specialty physicians and other referral providers. When the PCP feels a referral to a participating specialty physician or other referral provider is necessary he/she must enter a referral.

Occasionally members may require care that is not available within our provider network. When this situation arises, the PCP may request in advance and in writing, approval to send the member to a nonparticipating physician or other professional provider.

Members may change their selected PCP by calling or writing the Customer Service Department. PCP changes are effective the first of the month following notification. The request will be processed and a new identification card will be generated and mailed to the member. The PCP will be notified of this change via their monthly patient list. Your office can also verify updated PCP information through our physician and provider self-service application.