Updates to the 2018 Ambetter Network in Illinois
Provider Network Design
Beginning in 2018 the following hospitals will join the Ambetter Networks:
- Edward Hospital
- Elmhurst Hospital
- Holy Cross Hospital
- Little Company of Mary
- Kindred Chicago Lakeshore
- Louis A. Weiss Memorial Hospital
- Franciscan Hospital Systems (Dyer, St. Anthony, Crown Point)
- MacNeal Hospital
- Mount Sinai Hospital
- Northwest Community Hospital
- Palos Community Hospital
- Saint Bernard Hospital
- Schwab Rehabilitation Hospital
- Swedish Covenant Hospital
- Thorek Memorial Hospital
- Westlake Hospital
- West Suburban Medical Center
In addition, over 1,400 physicians and specialists will be joining the network.
Ambetter strives to provide access to a quality healthcare network with the goals of (1) keeping our premiums affordable and lowering costs for members and (2) focusing on making providers available who have a history of better healthcare outcomes. We want you to be and stay healthy!
To accomplish these goals, Ambetter contracts with a full range of practitioners and providers to provide all of the services that the Affordable Care Act describes as Essential Health Benefits. These include preventive care, hospitalization coverage, emergency services, and more. We make sure providers of all types are available within a certain geographic mileage or driving time from each of our members’ homes.
Ambetter contracts with providers who accept our contract terms, meet our credentialing criteria, and agree to our reimbursement terms. We regularly review the provider network and makes decisions about which providers remain in the network based on many factors. These include:
- Ensuring the availability of certain practitioners or hospitals in your area
- The ability of providers to meet our credentialing criteria
- Cost and efficient health care resource use data, to ensure your healthcare remains affordable
- Comparison of quality metrics that examine performance based on measures such as proportion of patients receiving evidence-based care for chronic conditions, diabetes and preventive care, well child checkups and immunizations, and others.