Member Frequently Asked Questions
BlueAdvantageSMHMO, Blue FocusHMO, Blue PrecisionHMO, and HMO Illinois® plan, you can call VILLAGEMD PHYSICIANS NETWORK, and we can make the change for you. If you wish to change to a new PCP (changes become active on the first of the month following the request to change), don’t hesitate to contact our customer services department at (800) 865-0093.
BCBSIL Medicare AdvantageHMO plan, you are instructed to call the contact number provided on the reverse side of your membership card.
Humana ® Inc HMO plan, you call them to make the change using the 800-number on your membership card.
WellCare Health Plans, Inc. Medicare HMO plan , you call them to make the change using the 800-number on your membership card.
Regardless of your HMO plan, you can always call VILLAGEMD PHYSICIANS NETWORK for guidance at (800) 865-0093!
A Woman’s Principal Health Care Provider (“WPHCP”) is an obstetrician/gynecologist (OB/GYN) who may or may not choose to act as a PCP. The WPHCP should coordinate care with the PCP. A female member may schedule office visits with her selected VILLAGEMD PHYSICIANS NETWORK OB/GYN without a referral from her PCP within the following requirement:
*The OB/GYNE must be a participating physician within VILLAGEMD PHYSICIANS NETWORK.
CHANGING YOUR OB/GYN If you have selected an OB/GYN affiliated with VILLAGEMD PHYSICIANS NETWORK and wish to change your OB/GYN to another in-network VILLAGEMD PHYSICIANS NETWORK OB/GYN, please get in touch with the customer service department at (800) 865-0093 .
PsycHealth Care Management, LLC is the exclusive provider of Behavioral Healthcare services to VILLAGEMD PHYSICIANS NETWORK members. PsycHealth is an NCQA accredited Managed Behavioral Healthcare Organization and has provided mental health and substance abuse disorder services for twenty years. To obtain services, members may self-refer by calling PsycHealth at (847) 864-4961. PCPs may also contactPsycHealth directly to getauthorization for their patients.
The member is authorized to self-refer for an initial visit to an in-network provider without a referral. For future visits, the treating in-network provider must obtain authorization from PsycHealth, Ltd to continue services. Additional authorizations are obtained through a portal.
If you have any questions about the In-network providers’ directory or to request authorization, please call the main number at (847) 864-4961 .
PsycHealth’s website: https://www.psychealthltd.com .
ACCOUNTABLE CARE ORGANIZATION
ACO Member Frequently Asked Questions
An Accountable Care Organization (ACO) is a group of doctors and other health care providers working together to provide and coordinate health service and care at the right time and in the right setting in a practical (high quality) and efficient (low cost) manner. The delivery of more effective and efficient care results in increased care access, population management, care management, and care self-management.
BCBSIL has developed a program with our group of physicians who have related practices to help PPO providers and PPO memberswork collaboratively towards a common goal to improve healthcare quality. [ COMMERCIAL ACO]
MERIDIAN works with the State of Illinois Medicaid member population base, offering many of the same services. [ MEDICAID ACO]
VILLAGEMD PHYSICIANS NETWORK is participating in Commercial ACO and Medicaid ACO, which are different from an HMO Medicare Advantage plan. You still have the right to use any doctor or hospital that accepts your insurance at any time, and it is always your choice about what doctors or providers you use or the hospital you visit. Regular visits to your primary doctor- including an annual health assessment- are essential to healthy living!
MEDICARE ADVANTAGE HMO
MEDICARE ADVANTAGE HMO Member Frequently Asked Questions
Depending on the Medicare Advantage plans offered in your area, you may have these options:
Important Things to Remember
You Must Continue to Pay Your Part B Premium
If you enroll in a Medicare Advantage plan, you will need to continue paying your Medicare Part B premium and any premium charged by your chosen plan. A monthly premium may apply and can vary based on the plan selected.
You Can’t Have a Medicare Supplement Insurance Plan and a Medicare Advantage Plan at the Same Time
Medicare Advantage plans are health insurance plans approved by Medicare and offered by private companies, and Medicare Advantage plans differ from Medicare Supplement Insurance Plans. If you enroll in a Medicare Advantage plan, you cannot purchase a Medicare Supplement Insurance Plan.
Member Information; https://www.bcbsil.com/medicare/member-services/mapd
BLUE CROSS COMMUNITY HEALTH PLANS
BCCHP & MMAI Member Frequently Asked Questions
Community Bases Center: https://www.bcbsil.com/bdnc/pullman
How to Enroll: https://www.bcbsil.com/mmai/how-to-enroll
Drug Coverage: https://www.myprime.com/en/medicines.html#find-medicine
Food Program: https://foodhub.com
Forms and Documents: https://www.bcbsil.com/mmai/member-resources/forms