Blue Cross Blue Shield Members

We are pleased you have chosen to learn more about the Blue Cross/Blue Shield Waiver Program at Rockford Memorial Hospital (RMH). BCBS is an important part of our network and provides coverage for more patients than any other commercial insurance plan at RMH. Since we began in 2006, more than 70,000 cases have been covered by the waiver program. The process is seamless and easy to access and our patients tell us they are extremely satisfied by how well the program works.

Very simply, when you need services or treatment at RMH, our staff will verify your coverage with BCBS and handle all the paperwork for you. We then waive the extra costs that you would otherwise have to pay for receiving care at an out-of-network provider. Take a few moments to read through this page and you’ll see why thousands of patients have taken advantage of the program.  If you have questions or need more information, call one of our BCBS waiver program specialists at (815) 971-6000.   


Frequently Asked Questions

1. I have insurance coverage with Blue Cross Blue Shield (BCBS) – can I receive services at Rockford Health System?

  • Yes, as long as you have out-of-network benefits under your plan.
  • Rockford Health Physicians, Rockford Health Medical Laboratories and Visiting Nurses Association all participate with BCBS plans – you can continue to see these providers at in-network rates.
  • Rockford Memorial Hospital has a different agreement in place with BCBS, one that allows us to offer the BCBS Waiver Program to you for accessing hospital services.

2. Are there specific requirements for me to qualify for the waiver program?      
Yes, you and any of your dependents are eligible to use the waiver program in the following cases:

  • The insurance plan providing your coverage offers a level of out-of-network benefits.
  • This program covers hospital services that you receive at Rockford Memorial Hospital – all other Rockford Health System providers are in-network.

3.  How does this waiver program help with saving on out-of-pocket expenses?
Rockford Memorial Hospital “waives” the difference between what you would have been responsible for at an in-network provider and what you are responsible for by coming to Rockford Memorial Hospital.  Your out-of-pocket expense is limited to what your in-network benefit levels are. 

4. My insurance plan offered either an HMO or an EPO that does not have out-of-network benefits?  Am I still eligible for the program?
No
. At the present time, the waiver program is designed to help with out-of-pocket expenses by “waiving” the difference between in and out of network benefit levels. If your plan does not provide out-of-network benefits, you would not be eligible for the waiver program. 

5. Can I receive information about the waiver program in advance of receiving services?
Yes
. The RMH team will help you with scheduling, completing any paperwork and verifying benefits, all before you actually arrive at RMH for services. 

6. Who can I call to assist with verifying benefits?
Rockford Memorial Hospital Business Office: (815) 971-6000. Our customer service representatives can assist you with insurance information, contact BCBS on your behalf; determine your benefit levels; and confirm that your plan includes any out-of-network benefits. 

7. Is there any other paperwork that needs to be completed?
No.
However, at the time of registration, we ask that you provide a copy of your current BCBS member identification card.   That allows our staff to correctly register you in our system and ensure that all billing and related information is sent to the correct location. 

8. Am I responsible for submitting any claims to BCBS? 
No
. Rockford Memorial Hospital will file a claim on your behalf directly to Blue Cross Blue Shield.

9.  What happens after I receive services?
BCBS will process the claim and forward an Explanation of Benefits (EOB) to you.  The EOB will explain the out-of-network benefits that have been applied. You do not need to supply Rockford Memorial Hospital with the BCBS EOB.
 
Rockford Memorial Hospital will adjust your account to the in-network benefit level based on the information obtained directly from BCBS specific to your policy.  If we are unable to obtain your in-network policy benefits from BCBS we will contact you by mail or phone.  A revised statement will be sent to you showing the in-network amounts that you may owe to Rockford Memorial Hospital.

10. What items should I bring with me?
Please bring an identification card, list of medications, and any applicable co-payments.

Key Contacts/Telephone Numbers:
 
Rockford Memorial Hospital Business Office: (815) 971-6000 

RHS Physician Referral: (815) 971-DRDR (3737)