What is Resurrection Physicians Provider Group?
What is Managed Care and how does an HMO work?
Why is it important to see my doctor regularly?

MEMBER SERVICES:

Who do I contact if I would like a list of RPPG physicians faxed to me?
Where can I find a printer-friendly list of RPPG physicians?
How do I select a Primary Care Physician?
How do I switch my Primary Care Physician?
Can I find the status of my referrals and claims online?

CLAIMS AND BILLING:

Who do I contact if I have a question about a bill I received?
Who do I contact if a claim has been denied by RPPG and I want to submit an appeal?
What if I have already submitted a written appeal to RPPG and the denial was upheld?
What options do I have if my insurance plan (BCBSIL, Humana) determined the denial was appropriate?
Who may file an appeal?

UTILIZATION MANAGEMENT AND REFERRALS:

Who do I contact if I need a referral?
When do I need a referral?
What if I need care after normal business hours?

GENERAL INFORMATION

Resurrection Physicians Provider Group, Inc. (RPPG) is an Independent Physicians Association (IPA). As an IPA, we have independently contracted with a network of physicians and facilities who provide care for our members. If you select a Primary Care Physician (PCP) who is contracted with RPPG, you will visit their private office. Your PCP will provide and make all decisions regarding your medical care, including referrals to specialists as needed.

Since inception RPPG has expanded our network to include hospital and specialty facility providers. Currently there are over 200 independent physicians and physician groups as well as over 10 healthcare facilities contracted with RPPG.

RPPG has contracted with many multi-lingual Primary Care Physicians who are ready to answer your health care questions. Each physician strives to provide regular preventive care to all patients throughout all stages of life.

RPPG continues to be awarded a Blue Ribbon by BlueCross BlueShield of Illinois for outstanding customer service. In addition, RPPG has earned Blue Stars for excellence in the following preventive care areas: Asthma Care, Breast Cancer Screening, Cervical Cancer Screening, Childhood Immunization, Colorectal Cancer Screening, Controlling High Blood Pressure, Diabetes Care, Influenza Vaccinations, Management of Cardiovascular Conditions, and Mental Health Care.

Understanding managed care and HMO requirements will help you get the most out of your health care coverage. Managed care is a complex system that involves the active coordination of, and the arrangement for, the provision of health services and coverage of health benefits. Most health plans in the United States today are some form of managed care. The goal of managed care is to control skyrocketing health care costs without sacrificing the quality of care.

A Health Maintenance Organization (HMO) is an organization that provides comprehensive health care for you and your family. Upon enrollment, you may choose a doctor to serve as your primary care doctor. This doctor monitors your health and provides most of your medical care, referring you to specialists and other healthcare professionals as needed.

If you haven't seen a doctor lately, you may not be as informed as you could be. A little knowledge goes a long way! Regular physician visits are one of the best things you can do for yourself and for your family.

In addition to annual checkups, recommended health screenings can identify potential health problems long before you notice anything is wrong. Early detection and treatment can prevent or minimize long-term complications. Get the most out of your life. Visit our Health & Wellness Center to find information on simple steps towards healthy living.

Who do I contact if I would like a list of RPPG physicians faxed to me?

If you would like to inquire about a physician who is not listed, have questions regarding any of our contracted physicians, or would like to request a list of our contracted physicians faxed to you, please e-mail customer_service@msogl.com or call Member Services at 773.695.4800.

Where can I find a printer-friendly list of RPPG physicians?

You may visit the physician pages on this website for detailed information on each of our contracted Primary Care Physicians. If you would like to print a list of doctors, a printer-friendly list of Primary Care Physicians and Obstetricians/Gynecologists can be found here. A printer-friendly list of specialists can be found here.

It is important to choose a PCP to fit your needs. With offices throughout the northwest side of Chicago, you will find an RPPG contracted physician with a location that is convenient for you. Many of these physicians speak multiple languages and have office hours to fit your busy schedule.

Are you more comfortable with a male or female doctor? Do you prefer a family practitioner or an internist? Do you need a pediatrician for your children? Are you a female member? Female members will also select an Obstetrician/Gynecologist in addition to their Primary care Physician.

Visit the physician pages on this website to view photos and information on RPPG contracted physicians such as languages spoken, physician specialty, office hours and locations.

By choosing an RPPG contracted physician, you gain access to one of the largest and most respected hospitals on the northwest side of Chicago, as well as a personal physician dedicated to proactive health care. For more information about our group or one of our contracted physicians, please review the information found on this website or call Member Services at 773.695.4800.

If you have an HMO insurance plan through BlueCross BlueShield (Blue Advantage, HMO Illinois, Blue Perform or Classic Blue) and have already selected Resurrection Physicians Provider Group (RPPG), you may contact our administrative office to switch to another physician within our group. To change your Primary Care Physician (PCP), please call Member Services at 773.695.4800 or e-mail customer_service@msogl.com. You will need to supply your name, insurance identification number, date of birth, the name of your current PCP, and the name of the new PCP you have chosen.

If you are not currently a member of Resurrection Physicians Provider Group (RPPG), you will need to contact your insurance plan to select an RPPG physician. You can find your plan’s customer service number on the back of your insurance card. For your convenience, the phone numbers for some of the most popular insurance plans are listed below:

BlueCross BlueShield of Illinois: 1.800.892.2803
Humana: 1.800.448.6262

Can I find the status of my referrals and claims online?

Yes. If you are an RPPG member, you can sign up for access to your online account through our secure member portal. You will be able to view and print your referrals and see the status of claims we have received. To sign up, click here and follow the instructions.

Who do I contact if I have a question about a bill I received?

Contact our claims department by calling 773.527.5203. Please be sure to have your paperwork handy when you call; including the name of the provider sending the bill, account number, date of service, amount billed and your insurance identification # (found on your insurance card).

Who do I contact if a claim has been denied and I want to submit an appeal?

You may contact our claims department by calling 773.527.5203. In most cases, you will be instructed to submit a written appeal to the claims supervisor:

Kim Seger
Claims and Operations Manager
Resurrection Physicians Provider Group
5860 West Higgins Avenue
Chicago, IL 60630

Please include all pertinent details such as date of service, name of the provider, amount billed, your insurance identification number (found on your insurance card) and a detailed explanation of why you feel the claim was denied in error. Please be specific and, if applicable, submit any supporting documentation with your appeal.

If you have submitted a written appeal to RPPG and we have maintained the denial decision, you have the right to appeal directly to your insurance plan. You will need to submit your appeal directly to your insurance company and they will independently review the appeal. The insurance plan will make a determination and inform all parties of their decision to either maintain the denial or approve the services for payment. To submit an appeal directly to your insurance plan, please see below:

BlueCross BlueShield
Appeals Committee
300 E. Randolph St.
Chicago, IL 60601
Fax: 312.616.1584

Humana, Inc.
Grievance & Appeal Department
PO Box 14546
Lexington, KY 40512-4546
Phone: 1.800.4HUMANA
Fax: 1.312.627.8574

Members have the right to contact the Illinois Department of Insurance Consumers Division located at either of the locations below:

You may file an appeal or your authorized representative may file an appeal on your behalf. If you want someone to file the appeal for you, a written authorization must accompany the appeal that includes your name, your member identification number, and a statement that appoints an individual (friend, relative, physician, or provider) to be your representative and to communicate with us about your claim. The written authorization must include the date and your signature. Your representative must also sign and date the statement of authorization. Please be sure the person you designate is willing to be your representative and will protect your rights.

UTILIZATION MANAGEMENT AND REFERRALS

Your Primary Care Physician (PCP) is responsible for coordinating your healthcare needs. A referral is as an actual document obtained from your PCP referring you to a specific facility or specialist for service. In most cases, your PCP will want to see you prior to writing a referral in order to accurately diagnose your condition and refer you to the appropriate specialist. You can find the phone number of your PCP on the physician section of this website.

Generally speaking, you will need a referral any time you seek medical care from a health care provider other than your Primary Care Physician (PCP) or Women's Principal Health Care Provider (WPHCP). If your PCP or WPHCP determines that you need to visit a specialist, they will issue a referral. The referral process is initiated by your PCP or WPHCP. As an HMO member, it is important to remember that you must get a referral before seeking care from a specialist. Referrals are typically written to see a specific provider/specialist, within a specified timeframe (usually 60 days), for a specific number of visits. Based on the nature of the referral, it may take up to five days to receive authorization. If you have any questions regarding the referral process, you can ask your primary care physician to discuss the referral process. If you need to seek emergency care, please contact your primary care physician as soon as possible after receiving services.

All of our primary care physicians have 24-hour answering services. If you need to contact your PCP after normal business hours, you can call their office. You will either be given instructions on what to do or you will be automatically transferred to the answering service. If at any time you feel you need to go to the emergency room, we recommend that you call your PCP first. If you are unable to call your PCP prior to an emergency room visit, please contact your PCP as soon as possible.

If your situation is non life-threatening, your first step is to call your primary care physician for treatment advice. If your primary care physician can't see you right away, or if the office is closed and you can't reach your doctor, you may visit one of our RPPG-contracted Immediate Care facilities. You do not need a referral from your primary care doctor to go to one of the locations listed on this website.