How are participating physicians and hospitals selected?
Participation in the HealthLink network programs is voluntary and subject to application and/or credentialing processes. Physicians, medical facilities, and other health care professionals apply for membership in the HealthLink network by completing an application or credentialing form and contract. HealthLink’s credentialing process includes, but is not limited to, the following elements, as appropriate to the health care profession or specialty of the applicant:

• Verification of license
• Accreditation or certification for hospitals and medical facilities
• Physician training
• Education and certification that is appropriate to the practice
• Professional standing and hospital admitting privileges

Additional considerations include the applicant’s willingness to participate in HealthLink’s Medical Management program, to observe HealthLink’s policies and procedures, and to be available and accessible to enrollees of health plans contracted with HealthLink.

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Am I limited to using only HealthLink network physicians, hospitals and other health care professionals?
No. However, health plans using the HealthLink Open Access network program offer three levels of benefits for covered services. You’ll be eligible for the highest level of benefits for covered services if you use physicians and facilities who participate in the HealthLink Tier I network. You’ll be eligible for a second, lower level of benefits for covered services if you use physicians and facilities who participate in the HealthLink Tier II network. You may also use out-of-network practitioners with further reduced benefits for covered services.

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Do I need to file a claim form when I use a HealthLink network physician or hospital?
Your participating physician or hospital will file all claim forms for you. You may be asked to sign a claim form or provide other information your health plan may require. Please respond promptly and directly to these requests from your health plan administrator so that medical claims may be processed in a timely manner.

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What do I need to do if I am going to be admitted to the hospital?
Before you are admitted to the hospital, you or your physician should call HealthLink Medical Management toll-free at 877-284-0102, unless otherwise indicated on your enrollee health ID card and health plan literature. Phone lines are open from 8:00-5:00 CST on business days. An answering service is available at all other times. In an emergency, you or your representative (a family member, your physician or hospital) should call HealthLink Medical Management as soon as reasonably possible. Your emergency admission will not be delayed.

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How do I find the physician I need?
The Physician/Hospital Locator organizes providers according to specialty. The primary specialties (General Practice, Family Practice, Internal Medicine, Gynecology and Pediatrics) are listed first, and the subspecialties follow alphabetically.

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How do I find the specialist I need?
Your physician may recommend a HealthLink participating specialist. However you may use any specialist of your choice, although the benefits available for covered services may be lower if you do not use a HealthLink participating specialist.

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Do I need a referral when obtaining care from a doctor other than my primary care physician?
The HealthLink Open Access network program does not require a referral from your primary care physician when you need specialist care. You may take your primary care physician’s advice, or you may use any specialist, in or out-of-network, and receive benefits for covered services. It is important to understand your specific health plan provisions in order to make the best decision regarding your benefit coverage.

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How do I identify participating specialists in radiology, pathology and anesthesia?
HealthLink endeavors to contract with all hospital-based specialists at participating hospitals. However, hospital network participation is not a guarantee that specialists in radiology, pathology and anesthesiology are contracted with HealthLink. Please contact HealthLink Customer Service at 1-800-624-2356 for verification of physician/hospital participation status in HealthLink.

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If I use a doctor or facility participating in the HealthLink Open Access Network, will I be eligible for Tier I benefits for covered services?
In order to qualify for Tier I benefits for covered services, you need to use a Tier I provider. If you use a Tier II provider, you will be eligible for Tier II benefits for covered services. Tier I and Tier II providers are in the HealthLink Open Access network but different levels of benefits apply for each tier.

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What is SpecialOffers?
SpecialOffers is an on-line vendor discount program providing health and wellness products and services. The SpecialOffers web site is accessible from the customized State of Illinois web site from www.healthlink.com.

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What is the Lifestyle Management program?
The Lifestyle Management program offers on-line support services to assist you in making healthier behavior choices in five key areas of: tobacco cessation, weight management, stress management, physical activity and diet/nutrition. The tobacco cessation component includes one-on-one telephone support from a professional coach who may recommend various nicotine replacement therapy treatments.

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Where can I get more information?
If you need more information about the HealthLink Open Access network program and its participating physicians, hospitals and other health care professionals, please call HealthLink toll-free at 1-800-624-2356.

If you need information about your health benefit coverage, please contact your health plan administrator, identified on your enrollee health ID card.

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