What is Ravenswood Physician Associates/Weiss Healthcare Services?
What is Managed Care and how does an HMO work?
Why is it important to see my doctor regularly?
MEMBER SERVICES
Who do I contact if I would like a list of RPA physicians send to me?
How do I contact my Primary Care Physician?
How do I select a Primary Care Physician?
How do I switch my Primary Care Physicians?
Can I find the status of my referrals and claims online?
CLAIMS AND BILLING
Who do I contact if I have a question about a bill I received?
Who do I contact if a claim has been denied and I want to submit an appeal?
What if I have already submitted a written appeal to RPA and the denial was upheld?
What options do I have if my insurance plan (BCBSIL, Humana) determined the denial was appropriate?
Who may file an appeal?
UTILIZATION MANAGEMENT AND REFERRALS:
Who do I contact if I need a referral?
When do I need a referral?
What if I need care after normal business hours?
GENERAL INFORMATION
Ravenswood Physician Associates (RPA) is an Independent Physicians Association (IPA). As an IPA, we have independently contracted with a network of physicians and facilities who provide care for our members. If you select a Primary Care Physician (PCP) who is contracted with RPA, you will visit their private office. Your PCP will provide and make all decisions regarding your medical care, including referrals to specialists as needed.
Weiss Healthcare Services is a satellite IPA affiliated with RPA. Weiss Healthcare Services is primarily affiliated with Weiss Memorial Hospital but also shares affiliation with the majority of the RPA network.
Founded in 1985 among a few-like minded physicians, RPA/Weiss and our 75 primary care and 200 specialist physician members, who speak more than 40 languages, strive to reach, educate, and serve the health needs of residents living within the greater north side of Chicago and the immediate northern suburbs.
RPA/Weiss has earned Blue Stars for excellence in the following preventative care areas: Childhood immunization, Prenatal/postpartum Care, Cervical Cancer Screening, Colorectal Cancer Screening, Controlling High Blood Pressure, and Diabetes Care.
Understanding managed care and HMO requirements will help you get the most out of your health care coverage. Managed care is a complex system that involves the active coordination of, and the arrangement for, the provision of health services and coverage of health benefits. Most health plans in the United States today utilize some form of managed care. The goal of managed care is to control skyrocketing health care costs without sacrificing the quality of care.
A Health Maintenance Organization (HMO) is an organization that providers comprehensive health care for you and your family. Upon enrollment, you may choose a doctor to serve as your primary care doctor. This doctor monitors your health and provides most of your medica care, referring you to specialists and other healthcare professionals as needed.
If you have not seen a doctor lately, you may not be as informed as you could be. A little knowledge goes a long way! Regular physician visits are one of the best things you can do for yourself and for your family.
In addition to annual checkups, recommended health screenings can identify potential health problems long before you notice anything is wrong. Early detection and treatment can prevent or minimize long-term complications. Get the most out of your life.
MEMBER SERVICES
If you would like to inquire about a physician who is not listed, have questions regarding any of our contracted physicians, or would like to request a list of our contracted physicians sent to you, please e-mail customer_service@msogl.com or call Member Services at (773) 868-2000.
You can contact your Primary Care Physician by calling the office number listed on our Find a Doctor page. If you do not know who your Primary Care Physician is, please contact Member Services at (773) 868-2000 and they will look up the information for you. You will need to supply your name, insurance identification number, and/or date of birth.
It is important to choose a PCP to fit your needs. With offices throughout the northwest side of Chicago, you will find an RPA contracted physician with a location that is convenient for you. Many of these physicians speak multiple languages and have office hours to fit your busy schedule.
Are you more comfortable with a male or female doctor? Do you prefer a family practitioner or an internist? Do you need a pediatrician for your children? Are you a female member? Female members will also select an Obstetrician/Gynecologists in addition to their Primary Care Physician.
Visit the Find A Doctor page on this website to view photos of RPA contracted physicians and find additional information such as languages spoken, physician specialty, office hours, and locations.
By choosing an RPA contract physician, you gain access to several respected hospitals located throughout the northwest side of Chicago and the northern suburbs, as well as a personal physician dedicated to proactive health care. For more information about our group or one of our contracted physicians, please review the information found on this website or call Member Services at (773) 868-2000.
If you have an HMO insurance plan through BlueCross BlueShield (Blue Advantage, HMO Illinois, and Blue Precision) and have already selected Ravenswood Physician Associates (RPA), you may contact our administrative office to switch to another physician within our group. To change your Primary Care Physician (PCP), please call Member Services at (773) 868-2000 or e-mail customer_service@msogl.com. You will need to supply your name, insurance identification number, date of birth, the name of your current PCP, and the name of the new PCP you have chosen.
If you are not currently a member of RPA, you will need to contact your insurance plan to select our medical group. You can find your plan’s Customer Service number on the back of your insurance care. For your convenience, the phone numbers for some of the most popular insurance plans are listed below:
BlueCross BlueShield of Illinois: 1(800) 892-2803
Humana: 1(800) 448-6262
Yes. If you are an RPA member, you can sign up for access to your online account through our secure Member Portal. You will be able to view and print your referrals, check the status of claims we have received, view lab results, and if you are enrolled in our Case Management program you can view goals and other educational materials regarding your healthcare needs. To sign up, click here and follow the instructions.
CLAIMS AND BILLING
Contact our Claims Department by calling (773) 868-2000. Please be sure to have your paperwork handy when you call; including the name of the provider sending the bill, account number, date of service, amount billed and your insurance identification number (found on your insurance card).
You may contact our Claims Department by calling (773) 868-2000. In most cases, you will be instructed to submit a written appeal to the Claims Supervisor:
Claims and Operations Manager
Ravenswood Physician Associates
5860 West Higgins Avenue
Chicago, IL 60630
Please include all pertinent details such as date of service, name of the provider, amount billed, your insurance identification number (found on your insurance card) and a detailed explanation of why you feel the claim was denied in error. Please be specific and, if applicable, submit any supporting documentation with your appeal.
If you have submitted a written appeal to RPA and we have maintained the denial decision, you have the right to appeal directly to your insurance plan. You will need to submit your appeal directly to your insurance company and they will independently review the appeal. The insurance plan will make a determination and inform all parties of their decision to either maintain the denial or approve the services for payment. To submit an appeal directly to your insurance plan, please see below:
BlueCross BlueShield
Appeals Committee
300 E Randolph St.
Chicago, IL 60601
Humana, Inc.
Grievance & Appeal Department
PO Box 14546
Lexington, KY 40512-4546
Phone: (800) 4HUMANA
Fax: (312) 627-8574
Members have the right to contact the Illinois Department of Insurance Consumers Division at either of the locations below:
100 W. Randolph St, Suite 15-100
Chicago, IL 60601
320 W. Washington St.
Springfield, IL 62767
You may file an appeal, or your authorized representative may file an appeal on your behalf. If you want someone to file the appeal for you, a written authorization must accompany the appeal that includes your name, your member identification number, and a statement that appoints an individual (friend, relative, physician, or provider) to be your representative and to communicate with us about your claim. The written authorization must include the date and your signature. Your representative must also sign and date the statement of authorization. Please be sure the person you designate is willing to be your representative and will protect your rights.
UTILIZATION MANAGEMENT AND REFERRALS
Your Primary Care Physicians (PCP) is responsible for coordinating your healthcare needs. A referral is a document obtained when your PCP, which refers you to a specific facility or specialist for services. In most cases, your PCP will want to see you prior to writing a referral to accurately diagnosis your condition and refer you to the appropriate specialist. You can find the phone number of your PCP on the Find a Doctor section of this website.
You will need a referral any time you seek non-emergent medical care from a health care provider other than your Primary Care Physician (PCP) or Women’s Principal Health Care Provider (WPHCP). If your PCP or WPHCP determines that you need a visit with a specialist, they will issue a referral. The referral process is initiated by your PCP or WPHCP. As an HMO member, it is important to remember that you must get a referral before seeking care from a specialist. Referrals are typically written to see a specific facility/specialist, within a specific timeframe (usually 60 days), for a specific number of visits. Based on the nature of the referral, it may take up to five days to receive authorization. If you have any questions regarding the referral process, you can ask your PCP to discuss the referral process. If you need to seek emergency care, please contact your PCP as soon as possible after receiving services.
All our Primary Care Physicians (PCPs) have 24-hour answering services. If you need to contact your PCP after normal business hours, you can call their office. You will either be given instructions on what to do or you will be automatically transferred to the answering service. If at any time you feel you need to go to the emergency room, we recommend that you call your PCP first. If you are unable to call your PCP prior to an emergency room visit, please contact your PCP as soon as possible.
If your situation is non-life-threatening, your first step is to call your PCP for treatment advice. If your PCP cannot see you right away, or if the office is closed and you cannot reach your doctor, you may visit one of our RPA Contracted Immediate Care facilities. You do not need a referral from your PCP to go to one of the locations listed on this website.