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Healthfirst NJ
821 Alexander Road, Suite 140
Princeton, NJ 08540

Want to become a Healthfirst NJ Medicare member? Have a question about our benefits? Contact us at:
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Monday - Friday, 8 a.m. to 6 p.m.

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Monday - Sunday, 8 a.m. to 8 p.m.

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Seeing a Specialist


A “specialist” is a doctor who treats only certain parts of the body, certain health problems, or certain age groups. For example, cardiologists treat only heart problems, and oncologists treat people who have cancer.




If you need special care that your Primary Doctor (“PCP”) cannot offer, he or she will recommend a specialist who can help you:

  • If your PCP sends you to another doctor (also known as a “referral”), Healthfirst NJ will pay for your care.
  • Depending on your plan, you may be responsible for your usual co-payment. Call us if you have questions about your co-pay.
  • Make sure the specialist takes Healthfirst NJ insurance. If you think a specialist does not take Healthfirst NJ or will not meet your needs, talk to your PCP about seeing a different specialist.
  • There are some treatments and services that your doctors must ask Healthfirst NJ to approve before you can get them. Your doctors should tell you if you need approval from Healthfirst NJ before receiving certain treatments or procedues - this approval is called pre-authorization or prior authorization. They will also help you get this authorization from Healthfirst NJ.

Things to Know About Specialist Doctors

When would I need to see a specialist?

If you need special care that your Primary Doctor cannot offer, he or she will recommend a specialist who can help you.

Some examples of specialists you might need to see are:

  • Podiatrist: foot doctor
  • Ophthalmologist: eye doctor
  • Orthopedist: bone doctor
  • Oncologist: cancer doctor
  • Endocrinologist: hormone doctor who treats problems like diabetes and thyroid issues
  • Dermatologist: skin doctor
  • Cardiologist: heart doctor

Click here to find specialists that take Healthfirst NJ insurance.

How do I choose a specialist?


Your Primary Doctor should recommend a specialist to you that takes Healthfirst NJ insurance. You can also call Member Services – we’ll help find a good specialist near you.

What if Healthfirst NJ doesn't cover the kind of specialist I need?


If we do not cover a certain type of specialist, we will get you the care you need from a specialist outside of the Healthfirst NJ network. Here’s how:

  • You or your Primary Doctor can call Healthfirst NJ’s Medical Management Department at 1-888-394-4327 (Monday - Friday, from 8:30 a.m. to 5:30 p.m.). Medical Management will help you find the right specialist to treat your condition.
  • If you need to see an out-of-network specialist, your Primary Doctor can send us an “Authorization Request” for that visit.
  • If we deny your request to see a specialist outside of your Healthfirst NJ plan or program, you can appeal our decision. Call us for help on how to appeal a decision.

If your Primary Doctor or Healthfirst NJ refer you to an out-of-network doctor, you are not responsible for any costs, except for co-payments. For more information, please contact Member Services.


Last update 2013-03-27 07:36