Member Frequently Asked Questions

Frequently you choose a primary care physician (PCP), commonly known as a family practice, internal medicine, or pediatric provider, during the application process and open enrollment. To confirm or change your selection, call VILLAGEMD PHYSICIANS NETWORK at (800) 865-0093 , and our customer services department will help you with choices. Remember, health maintenance organizations (HMOs) require you to choose a PCP for managing and coordinating your health care.

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 .

VILLAGEMD PHYSICIANS NETWORK does not require prior authorization to visit an in-network specialist office as long as PCP refers it. However, if you decide to see an out-of-network specialist without getting written authorization obtained from your PCP, you will be responsible for the charges.

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 .

You are financially responsible for “copayments”. If you should receive a bill for any cost greater than a copayment for authorized services, please call VILLAGEMD PHYSICIANS NETWORK at (800) 865-0093.
VILLAGEMD PHYSICIANS NETWORK does not issue insurance cards; you must call your HMO insurance provider for a new or replacement card. The card should name the medical group and the applicable “copayments”.
Please obtain your medical records from your previous physician as soon as possible. If you need a copy of your medical records, contact your current primary care physician – you may need to complete a request for the release of medical records form. Your new PCP can assist you with the transfer of medical records to their office.
You are encouraged to review your healthcare insurance information- including the Certificate of Covered Services/Benefits and the VILLAGEMD PHYSICIANS NETWORK welcome letter and to communicate with your PCP regarding the effective delivery of your healthcare needs. Finally, you can always call VILLAGEMD PHYSICIANS NETWORK at (800) 865-0093 for answers and guidance. Your complete satisfaction and good health will always remain our goals!


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!

Using an ACO’s service area with Primary Care Physicians and providers who practice together in a group (like VILLAGEMD PHYSICIANS NETWORK), The ENTITY refines the group of ACO members to include those who have a specific portion of services from designated providers within a specified time frame. Those members are then matched to a PCP with whom they have the most substantial relationship.
Being part of an ACO that is prepared to improve your access to care, coordinate preventive care for early detection, and manage effective and efficient care delivery through all participating providers align services to meet your healthcare needs. Follow-up and coordination of chronic care treatment and managing unnecessary specialty, ER, and inpatient care can reduce your cost of care for medical and behavioral services.


MEDICARE ADVANTAGE HMO Member Frequently Asked Questions

Medicare Advantage HMO is;
  • An alternative to the Original Medicare insurance program and administered by the federal government, Medicare Part C gives you the option to enroll in a Medicare Advantage health plan offered by private companies.
  • Medicare approves private companies that offer Medicare Advantage plans to provide and administer benefits for their members.
  • Members of Medicare Advantage plans must continue to pay their Part B premium
  • Part C plans cover the same services as Part A and Part B and may also offer additional benefits not covered by Original Medicare through
  • Additional benefits that may be available when you visit your Medicare Advantage PCP:
  • Dental, Vision, and Hearing Services
  • Health, Wellness, and Fitness Programs
  • Prescription Drug Coverage
  • A Provider Network to help managed cost
  • Emergency and Urgent Care
  • Transportation
  • All Medicare Advantage plans provide the following:
  • Medicare Part A (hospital insurance) coverage
  • Medicare Part B (medical insurance) coverage
  • Limits on the out-of-pocket costs you pay
  • Most include:
  • Medicare prescription drug coverage (Part D)
  • Provider networks to help manage costs
  • Extra coverage, such as vision, hearing, dental, and wellness programs
  • All Medicare Advantage plans cover:
  • Emergency and urgent care
  • Hospice care (covered by Original Medicare)
  • Plans can charge different copays, coinsurance, and deductibles for these services.

    Depending on the Medicare Advantage plans offered in your area, you may have these options:

  • HMO – Health Maintenance Organization With most HMO plans, you can only go to doctors, specialists, or hospitals within the plan’s network, except in an emergency. You may also be required to get a referral from your primary care doctor before visiting a specialist.
  • HMO-POS – HMO Point of Service Plan This HMO plan allows you to get some services out of the network for a higher cost.
  • PPO – Preferred Provider Organization With most PPO plans, you pay less if you use doctors, hospitals, and other healthcare providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside the network, but you may pay higher copays and coinsurance.
  • PFFS – Private Fee for Service PFFS plans are like Original Medicare: you can generally go to any doctor, health care provider, or hospital if they agree to treat you. A PFFS plan determines how much it will pay doctors, health care providers, and hospitals and how much you must pay when you get care.
  • SNP – Special Needs Plan SNPs provide focused and specialized health care for specific groups of people, such as those who have both Medicare and Medicaid, who live in a nursing home, or who have certain chronic medical conditions.
  • MSA – Medical Savings Account An MSA plan combines a high-deductible health plan with a bank account. Medicare deposits money directly into the account (usually less than the deductible). You can use the money to pay for your health care services during the year.
  • 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


    BCCHP & MMAI Member Frequently Asked Questions

    The Blue Cross Community Health Plans (BCCHP)is a program developed and administered by Blue Cross and Blue Shield of Illinois (BCBSIL) intended to support the delivery of integrated and quality managed care services to enrollees, supporting seniors, persons with a disability, families, and children (including special needs children) and adults qualifying for the Illinois Department of Healthcare and Family Services (HFS)Medical Program under the Affordable Care Act (ACA). BCBSIL has a network of independently contracted providers, including ourVILLAGEMD PHYSICIANS NETWORK physicians, hospitals, skilled nursing facilities, ancillary providers, Long-Term Services and Support (LTSS), and other health care providers through which BCCHP members may obtain covered services.
    This three-way partnership program includes CMS, the State of Illinois, and Blue Cross and Blue Shield of Illinois (BCBSIL)to provide integrated benefits to Medicare-Medicaid enrollees. The network will consist of independently contracted providers, including our VILLAGEMD PHYSICIANS NETWORK physicians, hospitals, skilled nursing facilities, ancillary providers, long-term services, and other health care providers through which members may obtain Covered Services. MMAI is available to individuals eligible for Medicare and Medicaid in the approved service area in the State of Illinois.
    Skip to content