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Patient checking in with a receptionist handing an insurance card in a lobby area

    In-Network Insurance

    In-Network Insurance

    All patients are encouraged to verify their benefits with their plan administrator. For the most accurate and up-to-date information please contact your insurance carrier (refer to your insurance membership card for contact information) or human resource department to see if Springfield Clinic providers are considered in-network for your plan.

    Participating commercial plans

    • Aetna, Including:

      • Aetna - HMO & PPO & ACA/Exchange Plans

      • Meritain Health & First Health Network

    • Blue Cross Blue Shield - PPO (see BCBS in-network breakout below)

    • CIGNA - HMO & PPO

    • Consociate Care - PPO

    • Current Health

    • Health Alliance Medical Plans - HMO, PPO, POS & ACA/Exchange Plans (through 12/31/25)

    • HealthLink - OAP & PPO

    • HealthSmart

    • HFN - PPO

    • HOPE Trust

    • Humana - Choice Care

    • Live 360 (Health Choices) *Excludes the ASC

    • Medical Associates Health Plans

    • Multiplan/PHCS

    • Springfield Clinic Advantage

    • UnitedHealthCare, Including:

      • UnitedHealthCare - HMO & PPO

      • UMR & GEHA

    State of Illinois Employees

    • Aetna - HMO & OAP

    • BCBS Blue Choice Plan - Tier 2 Provider (see BCBS in-network breakout below)

    • Consumer Driven Health Plan (CDHP) - Administered by Aetna

    • Health Alliance Medical Plans - HMO (through 6/30/25)

    • HealthLink - OAP 

    • Quality Care Health Plan (QCHP) - Administered by Aetna

    Exchange/Marketplace Plans

    • Aetna Marketplace Plans

    • Health Alliance Marketplace Plans (through 12/31/25)

    Medicaid Managed Care products

    • Blue Cross Community Health Plans (see BCBS in-network breakout below)

    • Blue Cross Community MMAI (see BCBS in-network breakout below)

    • Humana MMAI plan

    • Meridian Health Plan

    • MeridianComplete (MMAI)

    • Molina

    • Molina Dual Options Medicare-Medicaid Plan

    • YouthCare

    Government plans

    • Tricare - Non-network providers

    • VA/Optum VACCN - VA Choice/Patient-Centered Community Care Programs

    Medicare

    Medicare enrollees considering their Medicare Advantage options have the comfort of knowing that Springfield Clinic — all doctors, all services, all locations including the Ambulatory Surgery Center unless otherwise indicated — participates in the following plans. Selection of any of these Medicare Advantage plans will ensure current Springfield Clinic patients have continuity of care and any new patients will be welcomed into Springfield Clinic’s circle of care.

    The following options are currently available:

    • Aetna Medicare Advantage: HMO and PPO

    • Cigna Medicare Advantage:  HMO and PPO

    • Health Alliance Medicare Advantage

    • Humana Medicare Advantage:  PFFS, PPO and HMO

    • Medical Associates Health Plan (Cost)

    • UnitedHealthcare Medicare Advantage

    • WellCare Medicare Advantage

    Springfield Clinic Peoria Patients

    In addition to all plans listed, Springfield Clinic Peoria providers also participate in the following insurance plans:

    • Caterpillar Network administered by United Healthcare and BCBS

    • HealthPartners UnityPoint Health

    • OSF Direct Access Network

    • Health Plus (Specialty Providers Only)

    Blue Cross Blue Shield Developments

    Last updated 2/27/24

    Springfield Clinic and Blue Cross Blue Shield of Illinois have agreed to a new five year agreement that will allow patients/members to return to in-network status at Springfield Clinic beginning on Jan. 1, 2024. This agreement is for most BCBS plans except Blue Choice. If you have questions about plans and in-network status, please contact Springfield Clinic's Patient Advocate Center at 217.391.7086.

    IN-NETWORK (EFFECTIVE JAN. 1, 2024)

    OUT-OF-NETWORK

    • PPO*

    • Medicare Advantage PPO & Group PPO (XOD & JLX)

    • Some Medicare Advantage HMO (XOJ)**

    • Medicare Supplement (XOS)

    • Blue Cross Community MMAI

    • Blue Cross Community Health Plan (Medicaid)

    • Choice*

    • HMO**

    *OSF Employee Health Plan Tier 2.

     

    **Please verify network status with BCBS as some of these plans including those associated with PHAI (Site #774) are out-of-network while other plans are in-network.

    *Some Choice plans, like the one offered to State of Illinois Employees, have Tier 2 benefits that allow patients to utilize the PPO network. This can be identified by "BCO" on the front of the card, as well as information concerning Tiered Plans on the back of the card. Please verify network status with BCBS.

     

    **Springfield Clinic Surgery Center (formerly known as Springfield Clinic Ambulatory Surgery Center) and a few providers are in-network with HMO. Please verify network status with Springfield Clinic's Patient Advocate Center at 217.391.7086.

    Frequently Asked Questions

    Refer to the chart above to determine network status. If you still have questions, the best way to determine if your plan is in-network with Springfield Clinic providers is to reach out to your insurance carrier or the human resource department of your employer.

    No. Any services that were provided prior to Jan. 1, 2024, will still be considered out-of-network. Any services provided on or after Jan. 1, 2024 that are billed to your in-network BCBS plan would process as an in-network claim.

    Please contact your provider office via their new direct line phone numbers listed on their provider profile page or review the new direct dial location phone numbers on our website.

    We offer online scheduling with most primary care providers on our website. If you're an established patient, you can use the patient portal to communicate with your provider.

    No. If you've seen your provider within the past three years, you're still an established or active patient.

    Yes, all Springfield Clinic providers will be in-network with the traditional PPO plan as of Jan. 1, 2024. The best way to determine if your plan is in-network with Springfield Clinic providers is to reach out to your insurance carrier or the human resource department of your employer.

    Yes, all direct contracts will end on Jan. 1, 2024. You can view a breakout of in-network and out-of-network BCBS plans in the char above and refer to a comprehensive list of our in-network insurance plans below.

    Any Continuity of Care for a patient who was out-of-network and is now in-network with the traditional PPO plan will no longer be needed as of Jan. 1, 2024. If the patient has a Blue Choice plan, however, the Continuity of Care will still be needed. 

    We are committed to ensuring a smooth transition for our patients, and our staff will be available to help..  To receive specific information about this benefit we recommend you reach out directly to Blue Cross member services for assistance.

    If your plan is part of the in-network options provided by BCBS, Springfield Clinic will no longer automatically send a Good Faith Estimate when you schedule your appointments. However, if you wish to obtain a Good Faith Estimate for your planned services, please feel free to reach out to the Patient Advocate Center at 217-391-7086. We would be happy to create a Good Faith Estimate upon request.

    If you prefer to utilize your Good Faith Estimate and choose not to bill your service through your insurance, you may elect to use your estimate. When you arrive to check-in, kindly inform the front desk that you will be billing as Self-Pay. The Patient Access Specialist will assist you in completing a “Commercial Insurance and Medicare Advantage Waiver Form.”

    You are not required to sign a Commercial Insurance and Medicare Advantage Waiver Form if you will be billing your in-network plan. You would need to sign a waiver if you are choosing to be Self-Pay and pay out-of-pocket.

    This would depend on your Blue Cross benefits. You are always welcome to request a Good Faith Estimate by reaching out to our Patient Advocate Center at 217-391-7086, but we would advise you reach out to Blue Cross to discuss your insurance benefits in detail.

    Some benefit plans allow Blue Choice members to access the PPO Network as Tier 2. Patients with questions on whether their plan allows this or not should reach out to BCBS in order to confirm.

    Contact Us

    Need assistance or looking for more information? Our team is here to help! Contact Springfield Clinic's Patient Advocate Center at 217.391.7086 Monday through Thursday 8:00 a.m. - 7:00 p.m., Friday 8:00 a.m. - 5:00 p.m. and Saturday 8:00 a.m. - 12:00 p.m.