Blue Cross and Blue Shield of Illinois (BCBSIL) recently discontinued its Blue PPO product on the Illinois Health Insurance Marketplace beginning December 31, 2015. Members in Blue PPO for 2015 members, who did not make changes, were transferred automatically into the BCBSIL Blue Choice plan, a plan that does not include KishHealth System, part of Northwestern Medicine.
Who is affected?
This change affects only those patients who were enrolled in a Blue PPO plan through the Illinois Health Insurance Marketplace. Patients enrolled in a Blue PPO plan through an employer or another large self‐pay group are NOT impacted by this change. Medicare patients who purchase Blue Cross supplemental plans also are not affected.
How do these changes affect my access to care at KishHealth System, part of Northwestern Medicine?
BCBSIL’s Blue Choice plan does not provide in‐network coverage for healthcare services provided at any KishHealth System, facility or KishHealth System Physician Group provider. This includes office visits, lab work, diagnostic imaging, outpatient procedures and inpatient surgeries performed through the following entities, all part of Northwestern Medicine:
- Kishwaukee Hospital
- Valley West Hospital
- KishHealth System Cancer Centers
- KishHealth System Physician Group
- KishHealth System Home Care and Hospice
- KishHealth System Physical Therapy Centers
Can I still receive care at KishHealth System?
Yes, but as of January 1, 2016, healthcare services provided by KishHealth System, will not be covered at in‐network rates by your BCBSIL plan. Pre‐payment will be required prior to the date of any scheduled services.
Are my physicians covered by Blue Choice?
The Blue Choice plan does not cover physicians or providers who are part of KishHealth System Physician Group. If your physician is an independent practitioner, and is not employed by our medical group, you will need to contact your physician’s office to confirm coverage.
How can I continue to receive care through KishHealth System?
To remain in‐network with KishHealth System, and continue to receive care through our physicians and at all of our locations, you will need to enroll in a plan that includes KishHealth System. The following plans available through the Illinois Health Insurance Marketplace include KishHealth System, part of Northwestern Medicine:
- Land of Lincoln PPO
- Coventry PPO
- Health Alliance
How do I enroll in a plan that includes KishHealth System, part of Northwestern Medicine?
Patients currently enrolled in a BCBSIL Blue PPO or Blue Choice plan offered through the Illinois Health Insurance Marketplace can select a new plan during the open enrollment period, November 1 to January 31, 2016. However, if completed after December 15, there may be a gap in coverage.
- Visit getcovered.illinois.gov.
- Review the plans that include KishHealth System (Land of Lincoln PPO, Coventry PPO, Health Alliance, or Humana.), and choose the plan that’s right for you.
- For assistance, call 866.311.1119.
What are the deadlines for enrolling in a new plan on the Marketplace/Get Covered Illinois for 2016?
If you selected a new plan by December 15, 2015, your coverage began January 1, 2016.
If you selected a new plan by January 15, 2016, your coverage will begin February 1, 2016. If you selected a new plan by January 31, 2016, your coverage will begin March 1, 2016.
What if I decide to continue treatment at KishHealth System under the Blue Choice plan?
If you decide to continue treatment at KishHealth System under the Blue Choice plan, you will be responsible for 100 percent of the out‐of‐network charges incurred for all services provided by KishHealth System. Pre‐payment will be required prior to the date of any scheduled services. Charity Care funding assistance will not be available to cover the out‐of‐network charges.
If I stay with Blue Choice, where can I go for care to ensure it is covered by my plan?
To ensure that your care is covered by your Blue Choice plan, you will need to contact a BCBSIL representative at the number found on the back of your insurance card and request a list of in‐network providers.
I am in the middle of treatment. What will happen in terms of my current care?
For the outpatient treatment of existing medical conditions, to continue to receive care through KishHealth System, you will need to enroll in a plan that includes KishHealth System.
Who can I contact for assistance or additional information?
Get Covered Illinois (Illinois Health Insurance Marketplace)
For assistance navigating the Illinois Health Insurance Marketplace website, visit getcovered.Illinois.gov or call 866.311.1119.
Blue Cross and Blue Shield of Illinois
For questions about your current BCBSIL insurance plan, call 800.538.8833 or 855.636.8591.
KishHealth System, part of Northwestern Medicine
For a complete list of insurance plans accepted by KishHealth System visit our website at kishhealth.org. If you have additional questions, please contact us between 8 am and 4:30 pm Monday through Friday at 800.397.1521 ext. 153386.
Who can I contact if I want to file a complaint about my insurance provider?