More and more of our patients are covered by “managed care” health insurance. Managed care plans can usually be identified by the acronyms HMO, PPO, MCO, PHO, OHP and the like. Our physicians are increasingly being asked by insurance companies to see managed care patients. They are often asked to sign managed care insurance company contracts, to which we agree, in exchange for patients insured by the plan to be referred to us. Most managed care plans have requirements for us to follow. Should we fail to follow those requirements, we can be prohibited from seeing patients covered by that plan. You, likewise, could incur increased health care costs—costs not covered by your insurance.
There is a good chance that your insurance plan has one or more of these managed care requirements. If it does, we are obligated to follow them. These requirements may not always be pleasant or your medical treatment as timely as you would like, but they may be a part of your managed care program. Here are some common features of managed care plans:
| PLAN | PRODUCT |
|---|---|
| Aetna Beech Street Blue Cross Blue Shield - HMO Illinois Blue Cross Blue Shield of Illinois Blue Cross Blue Shield Medicare Advantage PPO CIGNA Healthplan of Illinois, Inc. |
HMO/PPO/POS/EPO PPO HMO* PPO Medicare FFS/PPO HMO/POS/PPO |
| Great West Health Network Healthcare's Finest Network HFN Humana Health Care Plans |
PPO PPO PPO PPO/EPO PPO/POS/HMO* |
| Multiplan PPONext Preferred Network Access |
PPO PPO PPO |
| Private Healthcare Systems Three River Provider Network UnitedHealthcare United Healthcare Group Medicare Advantage (Medicare State of IL Retirees) *for selected HMO sites |
PPO PPO HMO/PPO Medicare FFS/PPO |
If you do not see your health plan listed above, please contact Midwest Orthopaedics at Rush at 877 MD BONES (815.649.5992) for further clarification.