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

State of Illinois Employees

  • Aetna - HMO & OAP
  • BCBS HMO Illinois PHAI Site 314
  • Blue Advantage PHAI Site 314
  • Health Alliance Medical Plans - HMO
  • HealthLink - OAP 
  • Quality Care Health Plan (QCHP) - Administered by Aetna

Public Exchange Products (Healthcare.gov)

  • Blue Cross/Blue Shield – Blue Choice Preferred PPO
  • Health Alliance Medical Plans

Medicaid Managed Care Products

  • Blue Cross Community Health Plans
  • Meridian Health Plan

Government Plans

  • Tricare - Non-network providers
  • VA/Triwest - 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 — 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 HMO, PPO
  • Coventry HMO, PPO, PPS
  • Health Alliance
  • Humana Medicare PFFS, PPO, HMO

 

Definitions

Health Maintenance Organization (HMO):

HMOs offer prepaid, comprehensive health coverage for both hospital and physician services. An HMO contracts with health care providers, e.g., physicians, hospitals, and other health professionals, and members are required to use participating providers for all health services. Members are enrolled for a specified period of time. Model types include staff, group practice, network, and IPA.

Preferred Provider Organization (PPO):

Some combination of hospitals and physicians that agrees to render particular services to a group of people, perhaps under contract with a private insurer. The services may be furnished at discounted rates and the insured population may incur out-of-pocket expenses for covered services received outside the PPO if the outside charge exceeds the PPO payment rate.

Point-of-Service (POS):

Also known as an open-ended HMO, POS plans encourage, but do not require, members to choose a primary care physician. As in traditional HMOs, the primary care physician acts as a "gatekeeper" when making referrals; plan members may, however, opt to visit non-network providers at their discretion. Subscribers choosing not to use the primary care physician must pay higher deductibles and copays than those using network physicians.

Workers Compensation:

A state-mandated program providing insurance coverage for work-related injuries and disabilities.