New Patient Information
Fox Valley Medicine, Ltd. (FVM) is excited to welcome you and your family!
Understanding your HMO plan can help you get the most out of your health care benefits. Your plan provides for preventive services intended to help maintain your health and to promote early detection of disease. We encourage you and each family member to discuss with your physician(s) the screening tests that are appropriate and to follow his/her recommendations.
Managed care benefits vary depending our your benefit package. For specific information regarding your benefits, including copayment amounts or limits on care, please see your Description of Coverage or Certificate of Health Care Benefits Manual. Copayment amounts are due at the time of visit. Be sure to bring your current HMO identification card and valid I.D. with you to all appointments. We look forward to a long an healthy relationship and encourage you to take an active role in managing your health.
Choosing Your Primary Care Physician
The first and most important step is to choose your Primary Care Physician (PCP). Your PCP is your primary caregiver and medical advisor who will coordinate care including direction to a specialty care provider when needed. Each family member may choose a different PCP. Please notify FVM of your PCP selection by contacting the Customer Service team at 630-482-9758. You can also complete the Primary Care Physician Selection form and either fax or mail it to the address/number on the top of the form.
The availability of early morning, evening and weekend hours vary by PCP. Your PCP will advise you how to access medical care for routine appointments and provide guidance for when his/her office is closed.
Emergency care can save lives. It is important to know the distinction between the need for emergency care and a visit best handled by your PCP. Knowing in advance how to respond to a true emergency situation can help you avoid unnecessary out-of-pocket expenses and, most importantly, ensure proper care in the most appropriate setting.
If you are unsure if you need emergency care, you may contact your PCP for treatment advice. In situations when you feel you cannot call your PCP, such as a life threatening incident, call 911 or go directly to the nearest hospital emergency room. After an emergency room visit, be sure to contact your PCP within 24-48 hours or as soon as possible after receiving emergency treatment. Your PCP will assist in your follow-up care.
To ensure you have convenient access to medical care, your PCP offers extended hours for routine and immediate care. Please contact your PCP for their individual office hours. If your PCP is unavailable for immediate care services that are non-emergent, your physician may direct your to one of our contracted Immediate Care facilities. This option provides quality care with less expensive out-of-pocket expense for your and your family. Please note that routine visits, immunizations, and sports physicals are not a covered benefit at an Immediate Care location. Be sure to follow-up with your PCP after receiving care at an Immediate Care location.
No referral or authorization is required to utilize one of FVM's contracted locations. View the Immediate Care section for a list of contracted locations.
Authorizations/referrals are required to see a specialist when you have an HMO plan. Your PCP initiates the referral process by submitting a request to FVM. This request is then reviewed to ensure that you receive the most appropriate care and that requested service is a covered benefit under your health plan.
Please make sure you have an approved authorization/referral before seeking services outside of your PCP's office. Your PCP office can answer any questions you have regarding the process or status of authorizations/referrals.
Population Health Management
As part of your HMO care coordination benefits, FVM offers Population Health Management, which includes Condition Management, Case Management and Complex Case Management. You may be contacted by FVM if you qualify for the Population Health Management Program. This program is available at no cost to you.
• Condition Management - Members with a diagnosis of Asthma or Diabetes may qualify for Condition Managment.
• Case Management (CM) - Members may qualify for CM when additional support is needed for their medical needs.
• Complex Case Management (CCM) - Members qualify for CCM if you have multiple complex medical conditions.
For more information about qualifying for these programs or to opt out of a program, please contact the Utilization Management Department at 630-482-9701.
If you still have additional questions, please contact the Customer Service department at 630-482-9758. You may also view our Welcome Newsletter or Member Handbook for more information.
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