NorthShore University Health System Participates in Blue Precision HMO
In light of recent conversations about NorthShore University Health System, Blue Cross and Blue Shield of Illinois‘ (BCBSIL) has confirmed its active relationship with NorthShore and its participation in the BCBSIL provider networks.
The NorthShore system participates in the Blue Precision<sup>SM</sup> HMO network, offered both on and off the Health Insurance Marketplace for individuals and small groups. (Blue Precision HMO network also includes University of Illinois Medical Center, Advocate Health Care and Presence Health System, among others.)
In addition, NorthShore is included in the BCBSIL group business PPO and HMO networks. Blue Choice PreferredSM PPO and the new BlueCare DirectSM in collaboration with Advocate Health Care, both individual/small group networks, are the only networks we offer that do not include NorthShore.
We want to expand access to affordable health care through insurance plans that meet the needs of as many consumers as possible. Blue Choice Preferred PPO is a select network that gives our members access to quality hospitals, providers and other health care providers. The network is limited in order to keep costs as low as possible for our members who pay for their own insurance. In fact, the broad PPO that included all the major health systems was discontinued because we could not sustain it at an affordable price based on actual claims data.
Are there any plans available that include NorthShore University Health System?
The Blue Precision HMO includes a network of providers that includes NorthShore University Health System. NorthShore is not in the network of providers for Blue Choice Preferred PPO plans.
Does this mean I can’t use a NorthShore hospital if I choose the PPO plan?
NorthShore University Health System is not a participating provider in the Blue Choice Preferred PPO network. If you enroll in the Blue Choice Preferred PPO and then choose to get care at a NorthShore facility or see a NorthShore doctor, your PPO will cover your costs at the out-of-network benefit level, which means you’ll pay more of the costs. If you have a provider in the Blue Choice Preferred PPO network that refers you to a NorthShore hospital or specialist, your care will be paid at the network level of benefits, if the referral/authorization is approved by BCBSIL.
Why isn’t NorthShore in the PPO network?
Blue Choice Preferred PPO uses a select network of providers that gives BCBSIL members access to quality hospitals, providers and other health care providers. The network is limited in order to keep costs as low as possible for members who pay for their own insurance. Not every health system accepts the lower reimbursement levels that are required to keep this PPO as low cost as possible.