Find a Provider Near You

USFHP provides a network of some of the area’s leading primary care providers (PCP). Plan members choose a primary care provider (PCP) from one of our network provider groups.

Specialty providers received extensive medical training in specific medical field such as cardiology, dermatology or allergy.

If you have a complex health problem, your PCP may refer you to an USFHP affiliated specialist. The USFHP referral network is extensive and offers many qualified specialty providers.

Your PCP and specialty provider will work together as a team to meet your health care needs. This system ensures:

• Better communication
• Good coordination of care among your providers

The contracted referral network includes specialists at these medical groups.

If the specialty care you need is not available within the referral network, your PCP refers you to a non-contracted provider. When both your PCP and the Plan authorize your care outside of our referral network, it is covered by the Plan.

US Family Health Plan offers a full range of hospital benefits.

If you must be hospitalized, your PCP or specialty provider will make the arrangements for you.

Members must use hospitals that are affiliated with their PCP. The only exception is in an emergency. In the event of an emergency, go to the nearest hospital.

All services that are deemed medically necessary are covered. Hospital services may include:

• Semi-private room accommodations (a private room may be covered if a Plan provider determines it is medically necessary)
• Physician services related to medical treatment or surgery
• Specialized care units, such as intensive care or cardiac care units
• General nursing services
• Operating room, anesthesia and supplies
• Prescribed inpatient drugs
• Inpatient physical therapy and rehabilitation at the appropriate level of care
• Other medically necessary supplies and services

If you are experiencing a life-threatening emergency, dial 911.

Urgent care is for injuries or illnesses that are not life-threatening. Examples of urgent care situations include a sprained ankle, respiratory illnesses, sore throat, ear aches or a minor cut that needs stitches.

Members are covered anywhere in the world for emergency care and urgent care.

These are the steps to follow:

• During clinic hours: If you need urgent care, call your PCP’s office. All urgent care must be preauthorized in order to be covered by the Plan.
• After clinic hours: Even after hours, you must get authorization. Call your PCP's clinic for authorization before getting care. Your clinic’s phone system will direct you to an after-hours phone service.
• If you are traveling: If you become ill and need urgent care (non-life threatening), call your primary care physician to have your care authorized and coordinated. If it is after hours, call your clinic’s main number to reach the after-hours service. Be sure to notify the Plan within 24 hours or within the next business day of when you receive care.
• Payment: If you are asked to pay at the time of service, make sure to get an itemized statement from the provider. When you return to your coverage area, request from the Plan to have these expenses reimbursed.

Getting your prescriptions filled is convenient and easy. We offer an excellent pharmacy network.

The prescription drug benefit is comprehensive. You’ll find it’s one of US Family Health Plan’s most valuable benefits!

You can get your prescriptions filled at:

• Network retail pharmacies
• Mail-order pharmacy
• Designated clinic pharmacies within our network

TRICARE maintains an approved list of drugs, called a formulary. All drugs on this list are covered, subject to TRICARE coverage rules. See the TRICARE formulary.

Durable medical equipment (DME) includes items like wheelchairs, hospital beds and oxygen. It is covered by the Plan when medically necessary. Your PCP will work with our case management team to provide seamless care coordination.

DME is covered with prior approval by the Plan.

Skilled nursing facilities (SNFs) are places of residence for people who must have constant skilled nursing care. They are unable to do a significant amount of the activities of daily living. Adults who are 18 years or older and have had an accident or illness may stay in a SNF to get special therapy. They may get physical, occupational and other rehabilitative therapy.

SNF visits are covered when provided by an authorized provider. SNF services must be for the diagnosis or treatment of a specific illness, condition or set of symptoms. SNF admissions are covered with prior approval by the Plan.

Please follow the following steps:

• For SNF inquiries call Member Services at 800-585-5883, option 2.
• For SNF referrals, contact your PCP to request a referral.

The Plan provides home care when it is necessary for medical reasons and the patient is homebound, i.e. unable to leave the home. The care may include durable medical equipment. Home care also includes intermittent visits for physical, speech, nursing, or occupational therapy at home. These are provided only for short, defined periods.

Home care visits are covered with prior authorization by the Plan.

For home health inquiries call Member Services at 800-585-5883, option 2.

For home health referrals contact your PCP to request a referral.

Find an in-network ambulatory surgery center near you by calling the Member Service team at 800-585-5883, option 2 or search our directory.