IPA BCBSIL HMO plans operate on the basis that a Primary Care Physician provides, coordinates, and/or directs all of your medical care. It is important that each enrolled family member becomes established with a Primary Care Physician as soon as possible after the date of enrollment. Make sure you enroll with a Primary Care Physician under Site # 484 or # 751 as appropriate.
Adults may choose an Internist or a Family Practitioner as their Primary Care Physician. Children may have a Family Practitioner or a Pediatrician as their Primary Care Physician. It is very important to make an appointment with your Primary Care Physician and receive preventative or wellness services as soon as possible. Our goal is to keep you healthy!
You should show your Insurance card each time you see your Primary Care Physician or any physician, facilty (Urgent Care, Hospital, Abmulatory Center, Home Health Agency, Durable Medical Equipment provider, Pharmacy, etc.) where you have been referred.
Referral Process and Medical Benefits/Coverage
Your Primary Care Physician is responsbile for coordinating all of your medical care. This is an advantage for you. Your personal physician will have a complete medical record on your medical history and care; this ensures continuity and coordination of your care.
It is your Primary Care Physician’s responsibility to determine if the services of a Specialist are needed. The Primary Care Physician’s office will generate a Referral form to a Specialist, indicating the specific service to be provided. It will then be your resonsibility to make the appointment with the Specialist and provide a copy of your referral.
A referral is required for services outside of your Primary Care Physicians office, such as Specialist care, Home Health care, equipment for home, outpatient physicial therapy, diagnostic services, etc.
Female members may see a Women’s Principle Health Care Provider who is in the same group/Site # as your Primary Care Physician without a referral.
If you require hospitalization, your Primary Care Physician will arrange this for you.
You are allowed to change Primary Care Physicians. We recommend keeping Primary Care Physician changes to a minimum to ensure optimum continuity of care. To Change your Primary Care Physician, please contact us at: 815-600-8165 or you may submit a change of information form by mail to Illinois Physicians Alliance PO Box 7970 Westchester, IL 60154.
You may contact us at 815-676-6301 with any other questions on referrals or HMO guidelines