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Blue Cross Blue
Shield Waiver Program
Rockford
Memorial Hospital will bill
all
Blue Cross
Blue Shield
plans for inpatient and outpatient
services.
Blue Cross Blue Shield plans generally
have deductibles and/or coinsurances.
The deductible is an annual expense
which you must pay before your insurance
benefits can begin. Coinsurance is the
portion of the total bill which is the
patient’s responsibility to pay.
Rockford Health System values our Blue
Cross Blue Shield patients.
That’s why we are working hard to
strengthen our relationship with your
insurer.
Toward that end, effective
January 1, 2008 Rockford Memorial Hospital
and Blue Cross Blue Shield have entered
into a contractual agreement to better
serve our patients.
While Rockford Memorial Hospital
is still considered an out-of-network
facility, our Waiver Program is being
modified in an effort to serve you
better.
Remember, the Waiver Program is
for all hospital services.
The Waiver Program is simple.
Rockford Memorial
Hospital will waive
additional out-of-network costs for Blue
Cross patients. That means that when a
patient,
who has out-of-network benefits,
comes to
Rockford Memorial Hospital
for services, he or she will not pay any
more for services than they would pay if
Rockford Memorial Hospital
were an in-network
facility.
If your
services are of an urgent or an emergent
nature, your policy should consider your
claim under your in-network benefit
level.
If you have scheduled services with
Rockford
Memorial
Hospital,
you may be eligible for a reduction in
your deductible and coinsurance.
Program
Outline and Terms:
-
The member
must
have out-of-network benefits under
their plan.
- The member must
provide coverage information from
their Blue Cross Blue Shield
Explanation of Benefits (EOB) to
participate in this program. This
can be faxed, mailed, or brought
into our Business Office, Monday
through Friday from 8:00 a.m. to
4:30 p.m.
- To email the
coverage information from your EOB
click on the link below and fill out
the information.
- Once you have
provided the coverage information
from your EOB and benefit levels
have been determined, Rockford Memorial
Hospital will adjust
the difference accordingly.
- All patient
liability must be paid or reasonable
payment arrangements made within 30
days from the date the adjustment is
posted.
Please contact our
Customer Service Representatives online
or by telephone at (815) 971-6000 if you
have any questions, or need help
determining your benefits
To submit a Blue
Cross Blue Shield Coverage Information
form, simply click on the link below and
save this form to your computer.
Then, complete it and e-mail it to
rmhpfs@rhsnet.org.
Blue Cross Cover Information Form
Address:
Rockford
Memorial Hospital
2400 North Rockton Avenue
Rockford,
Il
61103
Phone: 815-971-4170
Toll –free:
1-800-987-4170 (outside 815 area code)
Fax: 815-968-0170
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