Advocate Aurora Health Accountable Care Organizations
At Advocate Aurora Health, we are committed to helping you live well. Thats why we work closely with Medicare to help ensure you not only receive high-quality care but that every dollar spent on that care is spent wisely.
What is an Accountable Care Organization ?
An Accountable Care Organization is a group of doctors, hospitals and other health care clinicians who agree to work together with Medicare to make sure you get the support you need to get and stay healthy and the care you need when youre sick. ACOs have agreements with Medicare to be financially accountable for the quality, cost of care and the experience you receive.
At Advocate Aurora Health, we have two affiliated ACOs. You may have received notification that your doctor is in one of these ACOs.
Does an ACO change my Medicare benefits?
Your doctors participation in an ACO doesnt change your Medicare benefits. An ACO is not an HMO managed care or Medicare Advantage plan. You still have original Medicare , and your Medicare services, rights and protections also havent changed. An ACO cant tell you which doctors and clinicians to see or hospital to visit and cant limit your Medicare benefits. Your doctor may make recommendations based on quality, but its always your choice when it comes to which doctors or hospitals you use.
What kind of providers are part of an Advocate Aurora Health ACO?
We work together to improve the health of our patients.
How does an Advocate Aurora Health ACO help me?
Its Time To Expect More From Your Medicare
Your health care coverage is an important part of your overall wellness. That’s why were collaborating with Quartz, a trusted insurance provider contracted with Medicare, to offer you 5-Star-rated Medicare Advantage HMO plans.
Once you enroll in Medicare, youll have the opportunity to review your coverage and make sure you have the benefits youll need to stay healthy during the Medicare Annual Enrollment Period, which runs every fall from Oct. 15 to Dec. 7.
Preauthorization Precertification Second Opinions
Three important ways health insurance coverage can change.
Your health insurance can vary based on many different factors. The 3 most common ways insurance coverage can change include:
Preauthorizations and precertifications: Many insurance companies require an approval, called pre-authorization or pre-certification, before your doctor can perform certain tests or admit you to the hospital. If your insurance provider needs a pre-authorization or pre-certification, youll have to request it yourself. Unfortunately, we cant do this for you.
Second opinions: Some insurance companies ask you to get a second opinion from another doctor before theyll agree to pay for certain surgical procedures. Contact your insurance company to get more specifics about second opinions.
Usual, customary and reasonable : Many insurance companies have pre-set payment limits assigned to certain medical procedures. They base the cost of each procedure on what they consider to be usual, customary and reasonable . However, the insurance companys ideas about cost are not always in line with the actual cost of care. If our fees differ from your insurances UCRs, youre responsible for the amount not covered by insurance.
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Cghc Small Employer Members Only:
If you are covered through your employer and live in the CGHC service area, you have the Envision network, too. However, you have coverage when youre out of the service area for urgent and emergency care through our First Health Complementary Network..
Some members who are covered by their employer may be enrolled in an Out of Service Area plan. If youre in an Out of Service Area plan, the First Health Complementary Network is your primary network for all care. Search for a provider here!
How To Change Medicare Plans
Medicare benefits vary from year to year, so be sure to review your Medicare plan materials annually to ensure that your current plan still meets your needs. You can look over each years Medicare plan at the beginning of October, or we strongly recommend discussing your Medicare options with an insurance agent.
As you re-evaluate your coverage each year, you may find that you need to change your plan during open enrollment in order to:
- Keep certain benefits
- Get a higher quality plan, such as a 5 star plan, if you are currently on a 3 star plan or below
- Swap your Part D plan to Medicare Advantage in order to keep your in-network provider
Whether youre already working with a local Medicare agent, have questions about how to find a Medicare agent, or have questions about your options, you can contact our patient enrollment coordinators for assistance. At Iora with One Medical, we work as a team to help you get the most from your insurance plan.
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But First Please Let Us Know You Have Read The Disclaimer
Disclaimer: All content above is solely the work product of the authors. Neonatology Solutions, LLC, makes no endorsement or statement of safety, efficacy, or appropriateness of any of the protocols, pathways, guidelines, or algorithms contained within. They should be thoroughly reviewed against any available evidence prior to adoption. This content is for informational purposes only and should not be construed or relied upon as a standard of care. Any questions or concerns should be directed to the authors and/or the listed contact person. Good clinical judgement should always prevail when applying any standardized approach. We recommend that institutions review these protocols, pathways, guidelines, and algorithms and accept, modify, or reject them based on their own institutional resources and patient populations. Neonatology Solutions, LLC, assumes no liability for any outcomes arising from use of these tools.
Vaccines To Prevent Illnesses
Vaccines and immunizations are an important part of staying healthy. They prevent many common illnesses and diseases.
Your primary care provider recommends the right vaccines for you based on your age, health history and other factors, such as working in a health care setting. We also offer easy access to immunizations and vaccines, including flu shots, in Aurora clinics and pharmacies close to your home, work or school.
Find out more about:
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When Is Payment Of My Bill Due
If theres a balance due, youll receive a billing statement in the mail or in your account on our LiveWell with Advocate Aurora Health app or website. The full balance is due on or before the due date shown on your billing statement. If the due date on your billing statement is now, payment of the full balance is due as soon as possible after you receive your billing statement and before the next statement is mailed.
Why Did I Receive More Than One Bill
There are two reasons you might receive more than one bill from Aurora:
- You may receive more than one bill if you’re financially responsible for more than one persons health care and you haven’t established a family billing account. A family billing account puts all of the bills you’re responsible for on one statement. To set up a family billing account, call the Patient Contact Center at .
- You may receive more than one bill if you receive services from Aurora Health Care and Aurora Health at Home during the same time period. Both of these service areas generate their own statements.
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A Partner In Your Benefits Plan
When you choose one of the benefits plans we participate in, you have access to an Employer Solutions representative who guides you through all your options. This representative helps you build the solution that best meets your employees’ needs.
We provide hands-on support for your employees, including assistance with:
- Finding high-quality providers
How Can I Pay My Medical Bill
In addition to paying in person, here are 3 easy ways to pay your Aurora bill:
- Pay online through your account on our LiveWell app or website or our secure online bill pay portal.
- Call our automated pay-by-phone system 24/7 at .
- Mail a check to: Aurora Health Care, P.O. Box 809418, Chicago, IL 60680-9418
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Can I Receive An Estimate For The Cost Of A Procedure Before I Receive The Service
You can get a free cost estimate in LiveWell to see a combination of your potential out-of-pocket costs for both hospital and professional services, or by calling us at . Keep in mind that your final bill will consist of actual services rendered and may differ slightly from the original estimate. The difference will be based on any additional services that were ordered during the course of treatment.
Can I Set Up A Payment Plan To Pay Off My Balance
We offer interest-free repayment plans. The length of the repayment plan depends on the total balance due. You must set up a payment plan within certain parameters to avoid collection activity. Accounts that are not protected by a payment plan will continue to age to external collection activity.
To get started, sign in to your account on our LiveWell app or website, or call us at .
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How To Change Your Primary Care Physician On Medicare
There are a number of reasons to consider switching primary care providers, such as changes in your insurance, practice location, level of service, communication, or if your current providers practice is closing or moving. You may also want to find a primary care provider that focuses on the needs of seniors, where preventive and coordinated care becomes crucial to your health.
At Iora, your health is our top prioritywe focus our efforts on getting to know you and your unique needs, so we can identify and treat health concerns early on. Our coordinated care approach also helps our providers get a full picture of your health inside and outside the practice. We collaborate with you, your family, and other specialists and hospitals to listen, support, and find the best treatment plan for you.
The good news is, if you receive coverage through Medicare Part B, you can go to any Medicare-participating physician or healthcare provider that is welcoming new patients.If you have a Medicare Advantage plan, you may have a specific network of doctors that are available to you.At Iora, were dedicated to providing exceptional care to adults 65 and older on Medicare, and our patient enrollment coordinators are here to help you learn more about how to change primary care physicians.
Will I Get A Bill
If there’s a balance left after your insurance company has paid its share, you might get a hospital bill or doctor bill. If that happens, you’ll get a statement in the mail showing how much the insurance company paid and what portion you have to pay.
You can pay your medical bill in person, by mail, over the phone, or online.
- To pay your medical bill by phone, call to speak to a representative or use the automated bill pay system.
- To pay online, sign in to your account on our LiveWell app or website or use our secure online bill pay portal.
- To pay by mail, send your payment to:Aurora Health Care, P.O. Box 809418. Chicago, IL 60680-9418
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How Do You Bill For Urgent Care Services
Urgent care is a service of Aurora clinics. Your urgent care visit will be billed as a physician office visit not an urgent care visit. That means you may not see the term urgent care on your billing statement at all. Also, any co-pay collected at urgent care will be an office visit copay.
Its important to fully understand your insurance coverage. If youre not sure how your insurance handles claims for physician office visits, or if you want to know what your copay will be, be sure to give them a call.
Health Screenings To Catch Early Signs Of Health Problems
Health screenings are tests that catch the earliest signs of serious conditions, such as cancer, diabetes and heart disease when you dont have symptoms. Screening tests may also show whether you face an increased risk for certain conditions, so you can take steps to reduce it.
Many screening tests require a simple blood or urine test. Some involve imaging or other procedures, such as a mammogram or colonoscopy. You can often have screenings during your regular checkup, or we can schedule your appointment at or near your local providers office. Learn more about health screenings.
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Plans Accepted By Froedtert & The Medical College Of Wisconsin Health Network
Please note that Medical College of Wisconsin is a separate organization and may not accept the below insurance plans. Please check with your physician about which plans he or she accepts.
The former United Hospital System with locations in Pleasant Prairie, Kenosha and surrounding communities is now Froedtert South and part of the Froedtert & the Medical College of Wisconsin health network. Froedtert South continues to operate as a locally led organization and retains its current health system departments, administrative services and insurance contracts. Visit froedtertsouth.com for insurance information.
As of January 2021, these plans are accepted by our hospitals, health centers and clinics.
- Allwell by Managed Health Services
- Americas PPO
- Anthem Blue Cross/Blue Shield *
- Anthem Medicaid
- Childrens Community Health Plan Medicaid
- Together with Childrens Community Health Plan
- Interplan Health Group / HealthSmart*
- Managed Health Services Medicaid
- Sheboygan Employer Health Network
*Plan is not accepted at all Froedtert & MCW facilities. Please verify with your insurance to see if your preferred facility is in-network with your plan.
My Insurance Company Says That If You Change The Coding They Will Pay My Bill Differently How Can I Get My Coding Changed
Our coding is done by certified coders who have a strong understanding of Federal and state coding regulations. They apply the most appropriate coding for the service provided based on the documentation recorded at the time of the service. While were happy to review coding to make sure it matches the documentation, were not able to make coding changes to facilitate additional payment by the insurance company.
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I Stayed In The Hospital Overnight But My Insurance Company Processed The Claim As An Outpatient Stay Is This Correct
When you were admitted to the hospital, your doctor may have placed you under Observation status. This gives him or her extra time to monitor your condition, decide if you can be treated as an outpatient, or see if youll need to be admitted to the hospital. If youre covered by Medicare, your doctor is usually granted up to 48 hours to make this decision.
If you stayed overnight but your insurance company processed an outpatient stay, its probably because you were admitted as an observation patient and your doctor determined your condition did not require an inpatient stay.
Medicare Annual Enrollment Period
Open enrollment takes place from October 15 December 7 each year. During this time, you can:
- Sign up for a new Medicare plan
- Switch from Medicare to Medicare Advantage
- Add a Medicare Part D plan to your current Medicare coverage
- Add a Medicare supplement plan to your current Medicare coverage
All changes go into effect on January 1 of the upcoming year. Be sure to review your plan each year, as plans change annually and the plan that worked for you one year may not be your best option in the following year.
If you do not choose a new plan during open enrollment, your existing coverage will continue into the following year. If you did not have previous coverage, you could be subject to a surcharge and pre-existing conditions may not be covered by your provider in the future, so its important to start planning before you turn 65.
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What Happens If I Can’t Pay My Bill In Full
If you cant pay your bill in full, contact us as soon as possible to discuss your payment options and prevent your account from being turned over to a collections agency.
Simply call or sign in to your account on our LiveWell app or website to learn about payment options.
If you dont have insurance, you may be eligible for special discounts or financial help. You can learn more about this on the back of your billing statement, by reading about our Patient Financial Assistance Program, or by calling .
Baycare Health System Contracted Insurance Companies
If you have insurance, it is important to verify that your plan is accepted by your providers. The plans listed below reflect insurance plans contracted for BayCare Hospitals, Outpatient Surgery Centers and Outpatient Imaging Centers. Be sure to contact your individual insurer to verify coverage. Not all providers accept the same insurance plans. Be sure to check with your providers before your procedure, if possible.
- View insurance plans accepted at BayCare Urgent Care Centers.
- View a current list of insurances accepted at BayCare Laboratories.
- View insurance plans accepted by BayCare Medical Group.
- Commercial Plans
- American Psych Systems
- Anheuser Busch Companies
* BayCare works with Insurers from across the country. If you would like to confirm your coverage, please contact your plan.
* Please contact 852-3116 or your physicians office if you would like an estimate of your financial responsibility for your planned hospital visit.
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