NSCG Physician Specialists are on staff at:
Northwest Community Hospital
800 West Central Road
Arlington Heights, Illinois 60005
St. Francis Hospital
355 Ridge Avenue
Evanston, Illinois 60202
2650 Ridge Avenue
Evanston, Illinois 60201
Glenview, Illinois 60025
NSCG participates in most Chicagoland health plans, PPOs and the following HMOs. Contact 847-328-NSCG for the very latest information.
The new era of medical insurance is so confusing to normal folks that it makes rocket science seem like child's play. Good, old fashioned health insurance, that paid the hospital or doctor 80% of the bill (after your deductible), leaving you with 20% to pay yourself...a plan that allowed you to be treated by any hospital or any doctor, of your own choosing, anywhere in the country, at any time, is now a relic of the past (this was called indemnity insurance). Today's insurance plans all come with fancy titles (HMO, PSO, PPO, IPA, etc.), slick, high priced advertising campaigns, and cleverly hidden agendas. True freedom of choice, allowing you to choose when, where, and by whom you will be treated, is a vanishing commodity.
To help you, our valued patients, when making your next purchase of health insurance, we have compiled a list of questions you should ask of your insurance representative or benefits manager. Make certain you get a clearly understandable answer to these questions before making your choice.
Q. Can I keep my present primary care physician?
A. Some physicians may be listed in an insurance companies provider book but have closed practices to managed care patients. Even if your present doctor is listed, he or she may not accept you once you change to a managed care plan. Ask your doctor before you make a change!
Q. I have a chronic condition for which I am followed and cared for by a specialist, in addition to my primary care doctor. Can I continue this practice?
A. Most managed care plans do not allow you to see a specialist at your own discretion, but require your primary care doctor to provide all of your care, and just refer you to a specialist when a new or pressing problem arises. In fact, most managed care plans actually monitor your primary care doctor to make certain he or she does not over utilize the consultation process. The managed care plan may actually reward your doctor for a low rate of referrals.
Q. What hospitals are available to me and what if my condition may be better served by a specialist located at an out-of-plan hospital?
A. Some managed care plans have extensive participating hospital lists, while others have very limited hospital selections. Most uncommon medical conditions can be adequately cared for at many hospitals, but could be far better cared for at an institution with special expertise in that area. Managed care plans frequently prevent patients from transferring to these institutions of special expertise, as long as some, albeit lesser, care can be provided at their contracted hospitals.
Q. What if I am out-of-town when I get sick, who or where will I get my care from? Will I need to travel home for care, and if so, who will pay the bill for this travel?
A. Many plans will only pay for emergency care when away from home, and once the crisis is subdued, require you to travel home to your contracted provider hospital. This is especially difficult for "snow birds". Travel expenses are virtually always the responsibility of the patient. The term "emergency" is always defined by the insurance company...not by you!
Q. How is my doctor paid by these new plans?
A. Unlike old-time (fee-for-service) medical care, many new plans actually pay your doctor more for not seeing you, than for seeing and caring for you. This is called "capitation", a system in which mathematicians calculate, and the insurance company pays your primary doctor a very small fee every month whether he or she provides you with no care, is at your hospital bedside day and night helping you through your crisis, cares for you in the office on multiple occasions, or returns your phone calls late at night. Some plans also provide your primary doctor with a cash incentive based on how infrequently hospitalizations occur, how brief hospital stays are, how few consultations are recommended, or how few tests are ordered.
Q. My premiums keep going up and I have heard a new plan advertised that is offering much lower rates, without a deductible, and has no paperwork hassle. Is this too good to be true?
A. The old adage ...you get what you pay for is as true in medical insurance as it is for a suit of clothes. Insurance companies cannot provide you with unlimited, unrestricted access to physicians or hospitals of your choice, and still offer premiums below the going market rate. Cut rate insurance inevitably means cut rate coverage, cut rate service, and loss of free choice.
Q. I am considering joining an HMO, do all doctors work for HMOs?
A. Most typical HMOs function like large corporations, as they employ physicians, nurses and physician assistants full time, while excluding private practice physicians. Many excellent doctors work for HMOs, although young physicians, just out of their training, tend to find their first jobs working for an HMO. Physician assistants (helpers) are very often used to screen patients either in the office, or on the phone, and decide whether a patient will even see the doctor.
As is true for all purchases, it is extremely important to be an informed consumer, but for health insurance, it can mean the lives of yourself and your loved ones. Be careful...be wise...ask questions, and expect direct answers.
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