Referrals and Authorizations

Referral

Family Health Network Healthy Referral and Authorizations If your doctor cannot treat you, your doctor will refer you to another doctor. Your doctor can also refer you to have a test or other services. This is called a referral. Your doctor will complete a referral form that you can bring to the other doctor, lab, hospital, or other health care provider.

Pre Authorization

Some health care services need to be approved before you get them. This is called pre-authorization. All services given by non-participating doctors must be pre-authorized.

If your doctor thinks you need a service he/she will send a referral form to FHN. Your doctor will share the information needed to make a decision on the service.

FHN’s Utilization Management staff will check the referral and the information given by your doctor. Our decision is based only on the right care and services for you. FHN will also check if the service asked for is a covered benefit or not.

A doctor reviews all denials and makes a final decision. If you do not agree with the decision, you can file an appeal. Your FHN member handbook says how to file an appeal.

If you have questions about what services are covered, call Member Services. The phone number to call is 1-888-346-4968.

Prior Authorization List

Attention ProvidersBehavioral Health

Important updates about behavioral health services that will impact providers. Effective June 1, 2016, FHN will contract with Behavior Health Specialist directly. Click below for more information

 Provider Notice                                              FAQs        

Member Services

If you have a question about your health plan, please call Member Services.  Hours are 8 a.m. to 5 p.m. Monday through Friday and 9 a.m. to 1 p.m. Saturday.


Si tiene preguntas sobre su plan de salud, por favor llame a la línea de Atención a Miembros Participantes. Horario de 8 a.m. a 5 p.m. de Lunes a Viernes y Sábado de 9 a.m. a 1 p.m.

1-888-FHN-4YOU
(346-4968)
TTY: 711

FLU Season

Flu season begins in October and lasts as late as May. Talk to your doctor about getting a FREE flu shot today.

Click here for more information

Service Area

FHN serves people living in the Chicago area: including Cook, DuPage, Kane, Kankakee, Lake and Will Counties.

Service outside of our Service Area

If you are not in our service area and you need care but it is not an emergency, please call us at 1-888-346-4968 TTY: 711. We will work with you to help you get the care and services you need. When FHN helps to arrange non-emergency services for you outside its service area, we will cover the cost. If you get services outside of our coverage area, we may not pay for those services.
If you are not in our service area and you need emergency care, call 911 or go to the nearest hospital.