Blue cross community mmai

If you have questions about plans and in-network status, please contact Springfield Clinic's Patient Advocate Center at Medicare Supplement XOS. This can be identified by "BCO" on the front of the card, as well as information concerning Tiered Plans on the back of the card.

Listed below are those insurance payers and products with which Horizon Health has direct participation agreements In Network at our Illinois locations. Patient responsibility may vary according to plan. Out-of-network plans may have higher expense for the patient. If your insurance plan is not listed below, please call your insurance carrier to determine coverage. Patients enrolled in the Medicare Advantage plans listed below are eligible for all services we provide, since we are contracted with these plans. We accept PPO advantage plans other Medicare Advantage Plans , but may be subject to limited coverage for elective surgery and inpatient stays, which could result in greater out-of-pocket expense. It is best to contact your plan to verify coverage and contracted providers.

Blue cross community mmai

It will open in a new window. To return to our website, simply close the new window. Refer to important information for our linking policy. The resources on this page are intended to help you navigate prior authorization requirements for Blue Cross and Blue Shield of Illinois BCBSIL government programs members enrolled in any of the following plans:. Government Programs Prior Authorization Summary and Code Lists Refer to the Summary documents below for an overview of prior authorization requirements, reminders and helpful links. Procedure code lists are provided for reference purposes. Pharmacy Benefit Prior Authorization Requirements — Prime Therapeutics, our pharmacy benefit manager, conducts all reviews of prior authorization requests from physicians for BCBSIL members with prescription drug coverage. Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and their health care provider. The BCBSIL Medical Policies are for informational purposes only and are not a substitute for the independent medical judgment of health care providers. The fact that a service or treatment is described in a medical policy is not a guarantee that the service or treatment is a covered benefit under a health benefit plan. Members should contact the customer service number on their member ID card for more specific coverage information. Availity is a trademark of Availity, LLC. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors. All rights reserved. The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider.

Any services that were provided prior to Jan.

Medicare Supplements fill the gaps in your Original Medicare 1. This is archive material for research purposes. Please see PDPFinder. To switch to a different Medicare Advantage plan or to change your location, click here. Although you pay no additional monthly premium, you must continue to pay your Medicare Part B premium.

It will open in a new window. To return to our website, simply close the new window. Refer to important information for our linking policy. Learn more. As a new independently contracted Blue Cross and Blue Shield of Illinois BCBSIL Medicaid provider or a new employee of a provider's office , we encourage you to take advantage of the online information and other reference material available to you.

Blue cross community mmai

The table below contains some of the services covered under your plan. Some of these services may require a prior authorization getting an approval from your plan. To learn more about prior authorizations, visit the Prior Authorization page. For a more in-depth list of covered services, limits, exclusions and services that require prior authorizations see your summary of benefits document. Your condition must be serious enough that other ways of getting to a place of care could risk your life or health. Ambulance services for other cases must be approved by the plan. Not covered outside the U. Contact plan for details.

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You are STRONGLY encouraged to obtain information on out-of-pocket expenses by calling your health plan using the toll-free telephone number on your insurance identification card. For the most accurate and up-to-date information please contact your insurance carrier refer to your insurance membership card for contact information or human resource department to see if Springfield Clinic providers are considered in-network for your plan. Patients with questions on whether their plan allows this or not should reach out to BCBS in order to confirm. You would need to sign a waiver if you are choosing to be Self-Pay and pay out-of-pocket. Furthermore, even if your insurance plan is listed, that is not a guarantee of in-network service. You can view a breakout of in-network and out-of-network BCBS plans in the char above and refer to a comprehensive list of our in-network insurance plans below. Please verify network status with BCBS. Patients enrolled in the Medicare Advantage plans listed below are eligible for all services we provide, since we are contracted with these plans. To switch to a different Medicare Advantage plan or to change your location, click here. All Rights Reserved. The care coordinator also may know what resources have been accessed for the member, what the member has been eligible to receive, and why the member may be ineligible for some services.

In addition to the above appointment timeframes, providers are contractually required to ensure that provider coverage is available for members 24 hours a day, seven days a week. In addition, providers must maintain a hour answering service and ensure that each primary care physician PCP provides a hour answering arrangement, including a hour on-call PCP arrangement for all members.

If you've seen your provider within the past three years, you're still an established or active patient. The following section will describe these benefits in detail. The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. To receive specific information about this benefit we recommend you reach out directly to Blue Cross member services for assistance. Most PDF readers are a free download. It is best to contact your plan to verify coverage and contracted providers. During this phase, you and the insurance company share your prescription costs. Procedure code lists are provided for reference purposes. Maximum out-of-pocket enrollee responsibility does not include prescription drugs. All patients are encouraged to verify their benefits with their plan administrator. Patient responsibility may vary according to plan.