Here are a few key updates from BCBSIL regarding the ongoing drama between BlueCross BlueShield of Illinois and Northwestern:
- 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 arrange 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 selecting the Blue Precision HMO plan, it’s important that your clients know how it relates to Northwestern Medicine and Northwestern facilities and specialists.
- 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.
- 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 members select one of these sites, they must get their 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 their PCP refers them to a specialist, that care will be paid as in-network benefits. But, if the 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, you may want to search Provider Finder® to see if your current doctor or hospital is in the network.