Clear Spring Health HMO Plan Provider Directory
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Clear Spring Health HMO Plan Provider Directory This directory is current as of November 1, 2019. This directory provides a list of Clear Spring Health’s current network providers. This directory is for the Illinois Service Area: Boone, Clinton, Cook, Du Page, Kane, Kankakee, La Salle, Macoupin, Madison, Mc Henry, Ogle, St. Clair, Stephenson, Will and Winnebago county. To access Clear Spring Health’s online provider directory, you can visit www.clearspringhealthcare.com. For any questions about the information contained in this directory, please call our Member Service Department at 877-384-1241, we are open 8:00 am to 8:00 pm Monday – Friday from April 1 – September 30 and 8:00 am to 8:00 pm Monday – Sunday from October 1 – March 31. TTY users should call 711. Out-of-network/non-contracted providers are under no obligation to treat Clear Spring Health members, except in emergency situations. Please call our Member Service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of- network services. Our plan has people and free interpreter services available to answer questions from disabled and non-English speaking members. We can also give you information in Braille, in large print, or other alternate formats at no cost if you need it. We are required to give you information about the plan’s benefits in a format that is accessible and appropriate for you. To get information from us in a way that works for you, please call Member Services or contact Office for Civil Rights. H5454_P052-10119_C Clear Spring Health has a contract with Medicare to offer HMO and PPO plans. Enrollment in Clear Spring Health depends on contract renewal. 1 Table of Contents Section 1 – Introduction .............................................................................................................. 3 What is the service area for Clear Spring Health? .................................................................. 5 How do you find Clear Spring Health providers in your area? .............................................. 5 Section 2 – List of Network Providers ........................................................................................ 6 Primary Care Providers (PCPs)............................................................................................... 6 Specialists ................................................................................................................................10 Hospitals................................................................................................................................112 Skilled Nursing Facilities (SNFs) .........................................................................................114 Outpatient Mental Health Providers... .................................................................................. 116 Other Ancillary and Facility Providers. ............................................................................... 127 2 Section 1 – Introduction This directory provides a list of Clear Spring Health’s network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage (EOC). You may choose a PCP by selecting a PCP from within the plan Provider Directory and calling Member Services to inform them of the change. The Provider Directory may be downloaded from the plan website at www.clearspringhealthcare.com, or requested from Member Services. Member Services may also check to see if a specific Provider you are requesting is within the network. Please call member Services at 877-384-1241, we are open 8:00 am to 8:00 pm Monday – Friday from April 1 – September 30 and 8:00 am to 8:00 pm Monday – Sunday from October 1 – March 31. TTY users should call 711. You will have to choose one of our network providers who are listed in this directory to be your Primary Care Provider (PCP). Generally, you must get your health care services from your PCP. A PCP should be your first point of contact for undiagnosed health concerns or health problems and routine health care needs. In addition to providing you care, your PCP will help arrange or coordinate the covered services you get as a plan member. This includes your x-rays, laboratory tests, therapies, care from doctors who are specialists, hospital admissions, and follow-up care. Referrals are not required with Clear Spring Health HMO plans, but your PCP should be your primary resource to use when seeking specialist and hospital care and coordination of your medical services. The network providers listed in this directory have agreed to provide you with your health care services. You may go to any of our network providers listed in this directory. In cases where out-of-network providers submit a bill directly to you, you should not pay the bill but should submit it to Clear Spring Health for processing and determination of your liability, if any. Please send the bill to the following address: Clear Spring Health: P.O. Box 4048 Scranton, PA 18505 You may get covered emergency medical care whenever you need it from the nearest hospital or provider. You don’t need to get approval first from Clear Spring Health or your doctor. If you have an emergency, Clear Spring Health will talk with the doctors who are giving you emergency care to help manage and follow up on your care. The doctors who are giving you emergency care will decide when your condition is stable and the medical emergency is over. 3 After the emergency is over, you are entitled to follow-up care to be sure your condition continues to be stable. Your follow up care will be covered by our plan. You must use network providers except in emergency or urgent care situations or for out-of-area renal dialysis or other services. If you obtain routine care from out-of-network providers, neither Medicare nor Clear Spring Health will be responsible for the costs. 4 What is the service area for Clear Spring Health? The counties in our service area are listed below. Illinois Service Area: Boone, Clinton, Cook, Du Page, Kane, Kankakee, La Salle, Macoupin, Madison, Mc Henry, Ogle, St Clair, Stephenson, Will and Winnebago county. How do you find Clear Spring Health providers in your area? The Clear Spring Health Provider Directory contains participating providers within our service area. There are provider sections in the directory, such as participating hospitals and specialists, where we list facilities and providers within our service area to provide you with comprehensive network information. There is also an alphabetical index of our network providers in the back of the directory for your convenience. If you have questions about Clear Spring Health or require assistance in selecting a PCP, please call our Member Service Department at 877-384-1241, we are open 8:00 am to 8:00 pm Monday – Friday from April 1 – September 30 and 8:00 am to 8:00 pm Monday – Sunday from October 1 – March 31. TTY users should call 711. You can also visit www.clearspringhealthcare.com. 5 Primary Care Providers Rosco Berwyn (PCPs) Crays MD, Gayle Acosta MD, Yanet Illinois 4282 E Rockton Rd 3100 S Oak Park Avenue Rosco, IL 61073 Berwyn, IL 60402 Family Medicine Clinton Augustin MD, Joel Boone 7000 W Cermak Road Breese Berwyn, IL 60402 Belvidere Beaty MD, Timothy Baldoceda MD, Blanca Baris MD, Alvydas 9401 Holy Cross Lane 3231 S Euclid Avenue 915 Alexandria Drive Breese, IL 62230 Belvidere, IL 61008 Berwyn, IL 60402 Klostermann MD, Brian Barragan MD, Lorena Kellenberger MD, Neal 9401 Holy Cross Lane 6447 W Cermak Road 1700 Henry Luckow Lane Breese, IL 62230 Belvidere, IL 61008 Berwyn, IL 60402 Mccleary MD, Marc Bass MD, Danielle Lopez MD, Cassandra 9401 Holy Cross Lane 3231 S Euclid Avenue 1700 Henry Luckow Lane Breese, IL 62230 Belvidere, IL 61008 Berwyn, IL 60402 Osborn MD, Jonathan Berndt MD, Sheila Lucietto-Sieradzki MD, Therese 9401 Holy Cross Lane 6840 Windsor Avenue 205 Cadillac Ct Breese, IL 62230 Belvidere, IL 61008-1733 Berwyn, IL 60402 815-544-0087 Fairview Heights Bhatnagar DO, Rupal Phoenix MD, James Mccleary MD, Marc Macneal Immediate Care 1747 Henry Luckow Lane 5 Ludwig Drive Berwyn, IL 60402 Fairview Heights, IL 62208 Belvidere, IL 61008 Blankemeier MD, Julie Ulmer DO, Meredith Trenton 7000 W Cermak Road Berwyn, IL 60402 1747 Henry Luckow Lane Garcia MD, Arnel Belvidere, IL 61008 409 E Broadway Chan MD, Bobby Belvidier Trenton, IL 62293 3231 S Euclid Avenue Berwyn, IL 60402 Giamalva MD, Andrea Cook Destani MD, Nejat 1700 Henry Luckow Lane Alsip Belvidier, IL 61008 6840 Windsor Avenue Dalal MD, Ankita Berwyn, IL 60402 Simmons MD, Mary 12246 S Pulaski Road Esparza MD, Nereida 1700 Henry Luckow Lane Alsip, IL 60803 Belvidier, IL 61008 Macneal Immediate Care Khan MD, Humaira Berwyn, IL 60402 Rockford 12246 S Pulaski Road Foley MD, Edward Alsip, IL 60803 Amir Khan MD, Mohammed 3231 S Euclid Avenue 2473 Mcfarland Road Townsend-Scott MD, Kimberly Berwyn, IL 60402 Rockford, IL 61107 12246 S Pulaski Road 3249 S Oak Park Avenue Lin MD, Billie Alsip, IL 60803 Berwyn, IL 60402 2473 Mcfarland Road Arlington Heights Gershberg MD, Michael Rockford, IL 61107 Edwards MD, Elena 6840 Winosor Avenue Sreedharan MD, Manoj 3295 N Arlington Heights Road Berwyn, IL 60402 2473 Mcfarland Road Arlington Heights, IL 60004 Gonzalez MD, Mayra Rockford, IL 61107 Matsumoto MD, Kojiro 7000 W Cermak Road Sy MD, Esther 2101 S Arlington Heights Road Berwyn, IL 60402 2473 Mcfarland Road Arlington Heights, IL 60005 Gross MD, Claire Rockford, IL 61107 Bellwood 3231 S Euclid Avenue Worthington DO, Mackenzie