Patient Frequently Asked Questions (FAQ)

What is Managed Care?
The Managed Care model of healthcare is directed at providing quality, cost-effective healthcare services. A Health Maintenance Organization (HMO) is one type of managed care organization which meets these objectives by coordinating patient care through a Primary Care Physician (PCP).

What is a Health Maintenance Organization (HMO)?
An HMO is a type of insurance plan in which all your medical care comes from approved providers. The chief advantages of an HMO are savings and simplicity. As long as you use approved providers, your out-of-pocket costs are low and there is minimal paperwork to deal with. HMOs also tend to cover more preventive medicine, to avoid more expensive care down the road.

What is an Independent Physician Association (IPA)?
An IPA is an association of independent physicians that contracts with independent physicians, and provides services to managed care organizations on a negotiated per capita rate, flat retainer fee, or negotiated fee for service. The typical IPA encompasses all types of specialty physicians to care for all aspects of patient care.

What is a Primary Care Physician (PCP)?
A PCP is a physician/medical doctor who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis.

Can I seek services at an Urgent Care Facility?
 Urgent care is a covered benefit when your Primary Care’s office is closed. Not all services are covered at an urgent care or after hours facility such as school physicals and immunizations. Please contact your PCP for guidance before seeking services at one of our contracted facilities.

Can I go to a physical therapy facility closer to my home?
Please check with your Primary Care Physician (PCP).

If I have a physical therapy copay, do I need to pay a copay at each visit?
Yes, if your plan requires a therapy copay you will be required to pay it at each visit.

Can I get an itemized list of all the copay amounts I have paid for “xyz” timeframe?
You can request that directly from the provider who performed the service.

Can I get a copy of an EOB to bill my secondary insurance?
You can request a copy of an EOB directly from the provider who performed the service.

Why is my claim showing unpaid on the BlueCross BlueShield of Illinois (BCBSIL) website?
Claims that are FVM responsibility will not show on the BCBSIL website.

Am I required to pay a copay if I have Medicare as my primary insurance?
If you have Medicare as your primary insurance, and your secondary HMO insurance plan requires a copay, the office will collect your copay amount.

If I selected my PCP on my BCBSIL application form, why do I still have to register the PCP with Fox Valley Medicine, Ltd.?
By selecting your PCP on your application, BCBSIL assigns you to the correct medical group, Fox Valley Medicine, Ltd. (FVM). Your BCBSIL application is not forwarded to FVM. You must call FVM to register your PCP so that he/she can see you are registered with FVM and can schedule you for an appointment.

Who do I call if I get a bill?
If you get a bill from an FVM member physician, feel free to contact Customer Service at 630-482-9758 for assistance. We would be happy to look at your claim and give you a payment status, or if needed follow up with the provider.