Insurance information

Edward-Elmhurst Health is dedicated to meeting the healthcare needs of our community, and helping as many people as we can be Healthy Driven. Edward-Elmhurst Health participates in a wide range of health insurance plans and is considered ‘in-network’ for these insurance plans.  In-network means that a larger portion of your medical expense will be covered and will likely reduce your out-of-pocket expense.  

Insurance plans accepted

Below is a listing of insurance plans accepted at each of our locations.* Since insurance coverage varies, a good habit is to always:

(1) Contact your insurance carrier to verify your specific coverage for services and 
(2) Contact your physician’s office to verify accepted insurance plans.

View insurance plans accepted below or click for a PDF version.

Plan Key
EH Edward Hospital EMG Edward Medical Group
Edward IC Edward Immediate Care EMMG Elmhurst Memorial Medical Group
EMH Elmhurst Hospital LOMG Linden Oaks Medical Group
Elmhurst IC Elmhurst Immediate Care EC Elmhurst Clinic
LOH Linden Oaks Hospital PPD Physician Practice Division
EHV Edward Health Ventures WIC Walk-In Clinic

COMMERCIAL INSURANCE PLANS

Commercial Insurance (also called private insurance) is a type of insurance coverage that can be paid for individually or as part of a group plan by an employer. It covers medical expenses that are incurred by the insured. Edward-Elmhurst Health participates with a wide variety of commercial insurance plans to meet the needs of patients in the community.


2017 Commercial Plans Products EH & Edward IC* EMH & Elmhurst IC* LOH EHV, EMG, EMMG, LOMG & WIC EC & PPD
Aetna HMO, PPO, POS, NAP
(ABH)**
Aetna Behavioral Health
(LOMG Only)
Aetna High Performance HMO ✔ 
Terming 12/31/17
✔ 
Terming 12/31/17
✔  
Terming 12/31/17
✔ 
Terming 12/31/17
✔ 
Terming 12/31/17
Ambetter Secure Care HMO
(Excludes LOMG)
Ambetter Balanced Care HMO
(Excludes LOMG)
Beacon Health Options
(Formerly Value Options)
PPO
Beech Street PPO
Blue Cross Blue Advantage HMO
Blue Cross HMO Illinois (HMOI) HMO
Blue Cross POS POS
Blue Cross PPO PPO
Blue Cross Options PPO PPO
Blue Choice MCNP PPO
Blue Choice Preferred PPO
Blue Precision HMO
Caterpillar PPO
(LOMG CATNET Only)
CIGNA HMO, PPO, POS
(CBH)***
CIGNA - C5 HMO, PPO, POS
(CBH)***
CIGNA Behavioral Health
(LOMG Only)
CIGNA Connect HMO
ComPsych PPO
Coventry HMO, PPO, POS
(ABH)**

(Excludes LOMG)
Coventry (First Health) PPO
(ABH)**

(Excludes LOMG)
Coventry One PPO
(Excludes LOMG)
Coventry (Personal Care)
(ABH)**

(Excludes LOMG)
Galaxy Health (UHC) PPO
Great West (CIGNA) PPO, POS, Open Access
Health Alliance PPO
(LOMG Only)
HealthLink PPO
HFN PPO
Humana ChoiceCare PPO
(LSNC)****
Humana HMO HMO
(LSNC)****
Humana Behavioral Health
(Formerly LifeSynch)

(LOMG Only)
Magellan
(LOMG Only)
MultiPlan PPO
Physician Benefit Trust PPO
Preferred Network Access PPO Termed 5/2016 Termed 5/2016
Terming 8/15/17
PHCS PPO
SmartCare/Imagine Health PPO
(ABH)**
Three Rivers PPO
TriCare Standard / Reserve Select PPO
(INPT Only)
Unicare PPO
United HealthCare Choice, Select, Plus HMO, EPO, POS
(Excludes LOMG)
United HealthCare Core/Navigate HMO, EPO, POS
(Excludes LOMG)

**(ABH) Aetna Behavioral Health
***(CBH) CIGNA Behavioral Health
****(LSNC) Life-Sync

GOVERNMENT SPONSORED INSURANCE PLANS

Government insurance (also called public insurance) is a type of insurance coverage that is subsidized or paid for entirely by government funds. There are a wide range of plans available. For instance, Medicaid is for some low income individuals or families. Medicare is for people age 65 or older, and those with certain disabilities or health problems.

Medicare Advantage Plans Products EH & Edward IC* EMH & Elmhurst IC* LOH EHV, EMG, EMMG, LOMG & WIC EC & PPD
Aetna Medicare Plans HMO, PPO
Blue Cross Medicare Advantage HMO, POS, PPO
Health Alliance PPO
(LOMG Only)
Humana Gold Plus HMO
(LSNC)****
Humana Choice PPO ✔ 
(LSNC)****
Sunrise Advantage ISNP 01/01/18 01/01/18 01/01/18 01/01/18
AARP Medicare Complete (plan 1 & 2) (UHC)
*now available in DuPage County in 2017
HMO
(Excludes LOMG)
AARP Medicare Complete Access (UHC) HMO
UHC Medicare Advantage PPO
Blue Cross Medicare 'Select' (part A only) Supplement
ACA Medicaid Plans Products EH & Edward IC* EMH & Elmhurst IC* LOH EHV, EMG, EMMG, LOMG & WIC EC & PPD
Blue Cross Community MMAI
(Excludes LOMG)
Blue Cross Community FHP, ICP
(Excludes LOMG)
Community Care Alliance (CCA) ABD
Family Health Network FHP
Humana ICP, MMAI
(Excludes LOMG)
IlliniCare FHP, ICP, MMAI Termed 10/01/17 Termed 10/01/17 Termed 10/01/17 Termed 10/01/17
Government Payer Plans Products EH & Edward IC* EMH & Elmhurst IC* LOH EHV, EMG, EMMG, LOMG & WIC EC & PPD
Medicare A
(hospital inpatient)
Medicare B
(hospital outpatient & physician)

(group therapy only)
Illinois Medicaid
(patients under 21 only)
Workers Compensation Plans Products EH & Edward IC* EMH & Elmhurst IC* LOH EHV, EMG, EMMG, LOMG & WIC EC & PPD
HFN
Coventry
Corvel

****(LSNC) Life-Sync

*Edward Immediate Care facilities are located in Bolingbrook, N. Naperville and Oswego. Elmhurst Immediate Care facilities are located in Addison, Hinsdale, Lombard and Oak Park. 

Insurance information is being provided for informational purposes only. Each individual is responsible for confirming which health care providers are in their insurance network.  Edward-Elmhurst Health cannot warrant that this information is accurate or up-to-date for every plan and product available which may resemble the products and networks listed here.

If you need additional information pertaining to our accepted insurance plans, please email InsuranceTeam@eehealth.org or call (331) 221-6650. Our hours are Monday through Friday, 7:00 am– 4:00 pm. 

For assistance with selecting a health plan from the Illinois Insurance Marketplace, contact a Patient Innovation Center navigator. Learn more

Need to pay your bill? View our bill pay page

Insurance FAQs

We have compiled some Frequently Asked Questions (FAQs) to assist you with your insurance questions. If you cannot find what you need, please contact us at pacustomer@edward.org.

Do I need pre-approval for a particular service?

You may need pre-approval (sometimes called pre-authorization or prior authorization) from your health plan before you have surgery or receive certain other healthcare services. Through the pre-approval process, your health plan confirms medical necessity; in other words, that the service is appropriate for your condition.  As a healthcare consumer, it is important to understand which services require pre-approval. If you receive care without first obtaining a required pre-approval, your health plan may not cover your claims. Pre-approval may be required for a variety of services, such as CT scans or MRI scans, not just for surgery. When in doubt, call your health plan to find out whether pre-approval is needed.

What if Edward-Elmhurst Health doesn't participate with my HMO or PPO?

If you have health insurance with a HMO or PPO plan with which we do not participate, you may still receive services at our facility. However, these services are considered “out-of-network” and may not be covered. You will be responsible for paying the bill in full, or for any balance not paid by your health insurance. Check with your HMO or PPO plan to understand your policy’s limitations.

Even though I gave the hospital and/or physician's office my health insurance information, I was also asked for my automobile insurance because my injury was due to an automobile accident. Why do you need this information?

For health services related to such injuries, health insurance plans normally only pay benefits after the auto insurance or workers' compensation insurance has paid their portion. This is also required for Medicare and Medicaid. If we do not provide the accident insurance information at the time of billing, the claim will be delayed or may even be denied until the information is provided.
 

What is a deductible?

A deductible is the amount that you may have to pay before your health insurance pays. Many plans offered today are called High-Deductible Health Plans where the deductible can be as high as $6,450 for single coverage or $12,900 for family coverage. Once the patient has met his/her deductible, the insurance usually pays a percentage of the remaining bills. The patient is liable for the unpaid percentage. Deductibles are reset annually, usually starting in January.

What is co-insurance?

Co-insurance is a form of cost sharing. After your deductible has been met, your insurance plan will begin paying a percentage of your bills. The remaining amount, known as co-insurance, is the portion due by the patient.

How will I know if my insurance company has paid my bill?

After your insurance company has paid its portion of your Hospital bill, we will send you a statement. This statement will indicate payments and adjustments that have been posted to your account and any balance you are required to pay. You may also receive an explanation of benefits (EOB) from your insurance company.
 

What's an Explanation of Benefits (EOB)?

An Explanation of Benefits is a document from your insurance company that shows how they processed your claim. It contains information such as co-pays, deductibles or non-covered services. EOBs should be kept for future reference.