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
  • Consumer Driven Health Plan (CDHP) - Administered by Aetna
  • Health Alliance Medical Plans - HMO
  • HealthLink - OAP 
  • Quality Care Health Plan (QCHP) - Administered by Aetna

Medicaid Managed Care Products

  • Blue Cross Community Health Plans
  • Meridian Health Plan
  • Molina
  • YouthCare

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
  • BCBS PHAI 773 Medicare Advantage HMO
  • Health Alliance
  • Humana - Medicare PFFS, PPO, HMO
  • Medical Associates Health Plan (Cost)
  • UnitedHealthcare Medicare Advantage (some plans do not include the Ambulatory Surgery Center)

Springfield Clinic Peoria Patients

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

  • Blue Cross Blue Shield HMO through site # 457 (Methodist First and UnityPoint)
  • Caterpillar Network administered by United Healthcare
  • HealthPartners UnityPoint Health
  • HealthSmart
  • OSF Direct Access Network
  • OSF Employee Health Plan (Humana – Tier 2)
  • Unity Point Accountable Care Plan – Medicare Advantage
  • UnityPoint Accountable Care Plan – Walmart
  • UnityPoint Health Plus
  • WellCare

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.