Why Can't I Understand if Northwestern Hospital Accepts the Blue Precision HMO Plan?

Because 2017 PPO rates increased many individuals out of PPO plans, hospitals such as Northwestern have made a late decision to accept an individual HMO plan or risk alienating their existing patients.

Additionally, HMOs are no longer small medical groups. They have merged into large doctor and hospital networks making it convenient to get referrals from a larger pool of desired specialists. 

Key Points to understanding how the plan works:
 

• As with any HMO plan, with the Blue Precision HMO, enrollees must choose a medical group and a primary care physician (PCP) within that medical group. Your clients’ PCPs provide basic health care needs and arranges any added care. If a member needs care beyond their PCP’s level of expertise, he or she will refer the patient to a specialist.
   
• Before members can go to a specialist, they will need to see their PCP first, even if the specialist is part of their PCP’s medical group.
   
• Before selecting the Blue Precision HMO plan, it’s important that your clients know how it relates to Northwestern Medicine and Northwestern facilities and specialists.
   
  
  • As in prior years, Blue Precision HMO offers access to several medical groups in the Chicagoland area, including:
    • Medical Group/Site 475: Northwestern Medicine Physician Partners – Central DuPage (Cadence) Hospital
    • Medical Group/Site 477: Northwestern Medicine Physician Partners – Delnor Community Hospital

When selecting one of these sites, you must get your primary care through the medical group and PCP at that chosen site. Please make certain they are aware that they must also get a referral from their PCP to get care from a specialist or any hospital.

• If the medical group can’t provide the care a member needs, and your PCP refers them to a specialist, that care will be paid as in-network benefits. But, if a member gets treatment with Northwestern Medicine doctors without a referral, those services will be looked at as out of network. This means the member will have to pay 100% of the out-of-network costs.
   
• Before choosing any plan, search Provider Finder^® to see if your current doctor or hospital is in the network.