Insurance Information

Your Loyola Medicine doctor is your strongest ally in the fight to stay healthy, and your insurance plan affects the doctor you can choose. Loyola accepts most major health insurance plans, including HMO, PPO and POS plans, Medicare and more. Please see our list of accepted plans. 

If you do not have health insurance, learn about the Affordable Care Act, how to enroll in insurance through the Healthcare Marketplace and how to apply for Medicaid, Medicare and the Children's Health Insurance Program.

Our Obstetrics and Gynecology Coverage Policy

In accordance with Illinois state law, Loyola allows open access to obstetricians and gynecologists for women who have enrolled in an HMO consistent with the HMO policy.

Loyola accepts many types of insurance, including policies from major insurers, dental and vision plans, Medicare replacement and supplemental policies, Medicaid, Affordable Care Act plans, and other coverage.

List of Accepted Insurance Plans

Loyola accepts many types of insurance, including policies from major insurers, dental and vision plans, Medicare replacement and supplemental policies, Medicaid, Affordable Care Act plans, and other coverage.

INSURANCE OR PAYOR NAME

TYPE OF PLAN

Aetna

HMO

Aetna

POS, PPO, EPO (Aetna Open Access; Choice POS II; Choice Plus; QPOS; Open Choice; Elect Choice; Meritain POS)

Aetna Signature Administrators

PPO

Beech Street

PPO

Blue Cross/Blue Shield of Illinois 

HMO (HMO of Illinois; Blue Advantage; Blue Precision) – Site 349 LUMC

BlueCross/BlueShield of Illinois 

HMO – (HMO of Illinois; Blue Advantage; Blue Precision) – Not Site 349 
Patient may be treated by Loyola specialist and hospital with referral but patient may not select a Loyola primary care physician.

BlueCross/Blue Shield of Illinois

PPO, including Blue Choice products

Blue Cross/Blue Shield of Illinois

PPO (Chicago District Council of Carpenters; Pipefitters Local 597; Carpenters Welfare Fund; ICHIP; Chicago Area IB of T; Chicago Laborers Welfare Fund; Midwest Operating Engineers; Federal Employee; MCHC – Loyola Medical Center.)

Blue Cross/Blue Shield Out-of- State (non-Illinois)

PPO, HMO, POS, EPO

Blue Cross/Blue Shield Coordinated Home Care

Home Health Care

Cadence Employee Health Plan

Employee Health Plan

Chicago Area IB of T (Local 703)

PPO

Christian Brothers Services

PPO

Cigna

PPO, HMO, POS, EPO

CoMed

PPO

CompCare of the Ozarks

PPO

DigiTrace

PPO – specialists only

DuPage Medical Clinic

IPA – specialists only

Elmcare LLC

PPO – specialists only

Formost Inc.

HMO

Hammond Clinic LLC

IPA – specialists only

HealthLink

PPO/HMO

HealthSouth Corp

PPO – hospital only

HealthSelect

IPA

HFN (Healthcare's Finest Network)

PPO, EPO

Hinsdale Hospital and Hinsdale Physicians Healthcare

IPA specialists only

Holy Cross Health Partners

IPA – specialists only

Holy Family Health Plus

IPA specialists only

Humana

HMO, POS, PPO

Independent Physicians at Mercy

IPA specialists only

Lake County Physicians Association

IPA – specialists only

LifeTrac Network

Transplant Network

MacNeal Hospital Chicago Health Systems

IPA – specialists only

McHenry County Physicians Organization (MCPO)

IPA specialists only

The Medical Care Group (TMCG)

IPA – specialists only

Mercy Physicians Association (MPA)

IPA specialists only

Monastery of the Holy Cross

PPO

Naperville HealthCare Associates

IPA specialists only

Optum Health

Transplant Network

PHCS

PPO

PPO Next

PPO

Preferred Network Access (PNA)

PPO

Preferred Plan Inc. (PPI)

PPO, EPO

Providers First PPO

PPO

Resurrection Physicians Provider Group (RPPG)

IPA – specialists only

Rockford Health Plans Inc.

HMO, POS, PPO
Patient may be referred but cannot select Loyola primary care physician

RML (Rush MacNeal Loyola) Specialty Hospital

Specialty Hospital hospital only

Select Health Network

HMO, PPO

St. Francis Health Care

IPA – specialists only

St. James PHO

IPA specialists only

Student Insurance Loyola (Stritch School of Medicine)

PPO

The Medical Care Group (TMCG)

IPA specialists only

Unicare

HMO, POS, PPO 

Union Health Services (SEIU Local 25 and Local 1 Health and Welfare Fund)

HMO, PPO
Patient may be referred but cannot select Loyola primary care physician

United HealthCare (UHC)

HMO, EPO, POS, PPO

US Steel – Garyworks

PPO – specialists and hospital only

USA Managed Care

PPO

Village of North Riverside

PPO

West Suburban Health Plans

PHO – specialists only

HEALTHCARE MARKETPLACE EXCHANGE PLANS

Blue Choice products 

PPO

 Blue Precision products 

HMO

Blue Cross Multi-state products  

Humana Chicago HMOx

HMO – offered in limited counties in Illinois

Humana Choice POS

POS – through December 31, 2016

United HealthCare Compass

HMO – through December 31, 2016

Harken Health (affiliated with UHC)

POS – through December 31, 2016

MEDICARE REPLACEMENT AND SUPPLEMENTAL PLANS

REPLACEMENT PLANS

 

Aetna Medicare Replacement

Medicare Replacement HMO, PPO

Blue Cross/Blue Shield Medicare Advantage

Medicare HMO Replacement Plan – with referral from primary care provider
Medicare PPO Replacement Plan – effective January 1, 2017

Humana Medicare

Medicare Replacement PPO, Private Fee-for-service (PFFS) – specialists only
Medicare Replacement HMO – with referral from primary care provider​

Secure Horizons

Medicare Replacement, PFFS

Sterling

Medicare Replacement, PFFS

Today’s Options

Medicare Replacement, PFFS

Unicare

Medicare Replacement, PFFS

United Healthcare - Medicare Advantage

Medicare PPO Group Replacement Plan – not participating in AARP Medicare Complete plans

SUPPLEMENTAL PLANS

 

AARP

Medicare Supplement

Bankers Life Medicare Select

Medicare Supplement

Blue Cross/Blue Shield of Illinois Medicare Select

Medicare Supplement

Galaxy Health Network

Medicare Supplement

Secure Horizons

Medicare Supplement

Sterling

Medicare Supplement

MEDICAID AND OTHER TYPES OF COVERAGE AND PLANS

Access to Care 

This charity program provides primary care to those who do not qualify for federal or state aid (ATC Location 180)

Aetna Better Health

Medicaid Managed Care 

Blue Cross/Blue Shield MMAI

Medicare/Medicaid Initiative Program (Duals)

Blue Cross/Blue Shield of Illinois

Medicaid Managed Care – effective January 1, 2017

CHAMPVA

Program for disabled veterans and family members 

DCFS

State of Illinois program through the Department of Children and Family Services

Early Intervention

Illinois Department of Human Services program for children up to age 3 who have developmental delays

Illinois Health Connect 

Medicaid Managed Care

Medicaid 

State Program

Molina Healthcare 

Medicaid Managed Care: Accountable Care Enterprise

VISION AND DENTAL PLANS

Always Vision

Vision Plan

Starmount

Vision Plan

Cigna Dental

PPO Dental Plan

DeCare Dental Networks

PPO Dental Plan

Delta Dental Networks

PPO Dental Plan

Delta Health Alliance

PPO Dental plan

Dental Health Alliance (DHA)

PPO Dental Plan

Metlife Dental PPO

PPO Dental Plan

Frequently Asked Questions About Insurance

We know you are likely to have questions. We hope you find all of the information you need here, but our provider relations staff can help you understand which insurance plans we accept. Provider relations can be reached by calling 708-216-5014.

If you have more questions, please call 888-584-7888. We'll put you in touch with the right person to answer your questions about health insurance, help you locate a doctor and provide general information.

How do I know whether Loyola Medicine is part of my insurance plan? 
Talk to a representative of the health insurance plan. Ask if the plan contracts with Loyola University Medical Center. If your health insurance plan requires you to use a primary care physician (PCP), ask your PCP to refer you to a Loyola-affiliated provider when necessary and appropriate. Loyola contracts with many providers.

How do I find a Loyola doctor who is in my health plan? 
Call us at 888-584-7888. We'll help you locate a doctor who meets your healthcare needs and participates in your insurance plan. 

With so many hospitals in the Chicago area, why should I choose Loyola Medicine? 
Loyola’s renowned doctors can meet your healthcare needs, from preventive care to hospitalization, rehabilitation and home care. And with numerous locations offering both primary and specialty care, there is a Loyola doctor conveniently located near your home or work.

Is Loyola Medicine a health insurance plan? 
No. But Loyola works closely with several health maintenance organizations. Loyola contracts with many major health insurance plans, preferred provider organizations and point of service plans for their members' care. There are many health plans that give you access to Loyola doctors and services.

Still have questions?
Call us at 888-584-7888. We'll put you in touch with the right people to answer your questions about health insurance, help you choose a doctor and provide general information.

Our Obstetrics and Gynecology Policy

Loyola allows open access to obstetricians and gynecologists for women who have enrolled in an HMO consistent with the HMO policy.

What Obstetric Care Includes

Obstetric care includes the following services:

  • An initial evaluation
  • Any 23-hour admission to rule out labor
  • Emergency/emergent antenatal admission for hypertension, metabolic disturbances, preterm rupture of membranes, third trimester bleeding, pre-eclampsia
  • Genetic counseling with amniocentesis for AMA, and/or abnormal triple testing and/or any other abnormalities
  • Hospital admission for delivery
  • One postpartum visit
  • Up to 12 subsequent routine prenatal care visits

Obstetric care includes the following tests:

  • 24-hour urine for proteinuria, preeclampsia
  • 3-hour glucose tolerance test (GTT) if glucose screen abnormal
  • 50 gram glucola
  • Amniocentesis if history of prior congenital or genetic abnormality
  • Amniocentesis if over 35 years, genetic counseling if amniocentesis shows abnormalities
  • Antibody screen
  • Blood type
  • Chlamydia
  • Complete blood count (CBC), liver function tests, fibrinogen and fibrin split products for preeclampsia
  • Gonococcus
  • Hemocrit
  • Hemoglobin
  • Hepatitis screen
  • HIV testing
  • Non-stress testing and/or biophysical testing (may substitute contraction stress test for biophysical profile) if post estimated date of confinement, post dates, intrauterine growth retardation, preeclampsia or decreased fetal movement
  • One basic ultrasound
  • Pap smear
  • Perinatal strep screen
  • Rapid plasma reagin (RPR)
  • Repeat ultrasound for third trimester bleeding, decreased fetal growth or size greater than dates
  • Rhogam x 1 if Rh negative
  • Rubella
  • Urine culture and sensitivity
  • Targeted level II sonography if prior history of congenital or genetic abnormalities
  • Triple test if less than 35 years​

What Gynecology Care Includes

Gynecologic care includes the following services:

  • Pap smear
  • Visits

Gynecologic care includes the following tests:

  • Blood tests including CBC, HB and HCT
  • Cervical/vaginal culture
  • Colposcopy (protocol necessary)
  • Endometrial biopsy
  • FSH and LH tests
  • Incision and drainage (I and D) of abscesses and cysts
  • Pelvic ultrasound
  • Pregnancy test
  • Quantitative serum HCG
  • Routine mammogram over the age of 50 years
  • Urinalysis
  • Urine culture
  • Vulvar biopsy​​

Please contact your insurance company for more information regarding its policy on open access to obstetricians and gynecologists.

Affordable Care Act 2017 Plans and Updates

Loyola is participating in these 2017 Marketplace plans :

Blue Cross Blue Shield:

  • Blue Choice products (PPO)
  • Blue Precision products (HMO)

Humana:

  • Chicago HMOx (offered in limited counties in Illinois)

Learn more about the Affordable Care Act and how to get coverage or renew you Healthcare Marketplace Insurance.

Medicare Replacement and Supplemental Plans

REPLACEMENT PLANS

 

Aetna Medicare Replacement

Medicare Replacement HMO, PPO

Blue Cross/Blue Shield Medicare Advantage

Medicare HMO Replacement Plan – with referral from primary care provider
Medicare PPO Replacement Plan – effective January 1, 2017

Humana Medicare

Medicare Replacement PPO, Private Fee-for-service (PFFS) – specialists only
Medicare Replacement HMO – with referral from primary care provider​

Secure Horizons

Medicare Replacement, PFFS

Sterling

Medicare Replacement, PFFS

Today’s Options

Medicare Replacement, PFFS

Unicare

Medicare Replacement, PFFS

United Healthcare - Medicare Advantage

Medicare PPO Group Replacement Plan – not participating in AARP Medicare Complete plans

SUPPLEMENTAL PLANS

 

AARP

Medicare Supplement

Bankers Life Medicare Select

Medicare Supplement

Blue Cross/Blue Shield of Illinois Medicare Select

Medicare Supplement

Galaxy Health Network

Medicare Supplement

Secure Horizons

Medicare Supplement

Sterling

Medicare Supplement