Q: Do all members of my family have to choose the same doctor?
A: No. Each family member may choose their own doctor as long as the doctor is within the West Towns PHO network and he or she accepts your insurance.
Q: How can I find out if a doctor I'm interested in accepts my insurance?
A: Call the insurance company or the physician's office.
Q: How can I find out if I have a co-payment?
A: In most cases, it is listed on the front of your insurance card. If not, call the member services telephone number listed on the back of your insurance card.
Q: How can I find out the names of participating providers in the Gottlieb/West Towns PHO network?
A: Refer to your provider directory given to you by your insurance company or click on PHO Physician Finder.
Q: How can I obtain a referral for services that are not provided by my primary care physician?
A: Your primary care physician coordinates your overall healthcare and determines the need for your specialty care referrals for medically necessary services. If you need specialty care, your primary care physician will refer you to one of the specialists associated with our group. If a referral is denied, the reason, the alternate treatment, a telephone number for Q: s, and the appeals process will be communicated to you in writing. Be sure to verify the date and type of referral you receive. You should always see or contact your primary care physician before seeking care from a specialist.
Services rendered outside of the Gottlieb/West Towns PHO network may not be covered if prior authorization has not been obtained from your primary care physician.
Q:How do I access my behavorial health benefits?
A: Behavorial health referrals vary depending on your insurance plan:
- Blue Cross Blue Shield of IL (Blue Advantage and HMO IL) - Please contact your primary care physician for a referral.
- Humana HMO - Members self refer by calling CorpHealth at 1-800-331-9040
- Unicare HMO - Members self refer by calling Wellpoint Behavorial Health at 1-800-746-6294
Q: How do I access my chemical dependency benefits?
A: Please contact your insurance provider by calling the telephone number on your medical card.
Q: What are my rights as a Gottlieb/West Towns PHO patient?
A: Click here to view patient rights and responsibilities.
Q:What if I have a problem?
A:Call West Towns PHO and ask to speak with the Director of Customer Relations.
Q:What is a co-payment?
A:A fee HMO members pay to cover costs of paperwork and administration for each office visit or pharmacy prescription filled.
Q:What is a PPO?
A:Preferred Provider Organization - PPOs are managed care organizations that offer patients access to a wide variety of doctors through an array of integrated delivery systems (i.e, networks of doctors).
Under a PPO benefit plan, patients retain the freedom of choice of doctors but are given financial incentives (i.e., lower out-of-pocket costs) to use members of the preferred doctor network.
Q:What is an EPO?
A:Exclusive Provider Organization: A form of PPO in which patients must visit a caregiver who is on the EPO panel of doctors. If an outside doctor is visited, the EPO will offer limited or no coverage for the office or hospital visit.
Q:What is an HMO?
A: A form of health insurance in which patients pay a monthtly premium in advance for health care. Coverage typically includes inpatient and outpatient care with reduced out-of-pocket costs (i.e., no deductible), no paperwork (i.e., insurance forms) and only a small co-payment for office visits. Usually patients are required to select a primary care doctor from a list provided by the HMO.
Q:What is the difference between a Family Practitioner and an Internist?
A: An Internist services older patients, typically starting at the age of 16. A Family Practitioner is not limited to age, he/she will see patients starting at newborn.
Q:What is the PHO?
A:An integrated health care delivery system which combines the services of a hospital and group of doctors. Together the organization enters into contract agreements with managed care companies in order to provide medical care for patients.
Q:What role does Gottlieb/West Towns PHO have in managing my health care?
A:We are a medical group that coordinates your care along with your primary care physician. We manage your eligibility status, referrals and medical claims payments.
LOYOLA UNIVERSITY HEALTH SYSTEM
