County Care, a health insurance plan, is basically a sub-division of Medicaid in Illinois, though it may not be funded that way. As health insurance, County Care is meant to cover adults 19 – 64 years old who don’t qualify for Medicare or Medicaid, but also don’t have the income to be able to afford paying for their own insurance. (County Care’s income limit is $16,105 per year for an individual or $21,707 for a couple. Like with most government services, income is likely to mean both earned income, such as through a job, and unearned income, such as unemployment insurance, SSDI, and SSI.) County Care is NOT Medicaid and covers fewer providers and services than Medicaid does. However, it is free to sign up for and to have.
You can sign up for and learn more about County Care here: http://countycare.com/
Note: People 18 and under might be covered by a Medicaid program like All Kids (http://www.allkidscovered.com/), if they are not already covered by their parents’ insurance. Once someone turns 65 years old, they might become eligible for Medicare due to their age.
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The observations below were current in January 2014. I don’t know if County Care’s referral system, aka its Provider Portal, is now more accurate or not. In case it isn’t, I’m keeping this post for now.
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From my own limited experience, County Care appears to be set up like a HMO, in that you have to have a medical home/primary care physician (PCP), and if you need to see a specialist, you have to get a referral from the primary care physician and also get that referral approved by County Care if you want to be able to see the specialist without getting a medical bill. If you try to see the specialist without getting a referral first, County Care may not cover that doctor’s visit, even if that specialist is in-network.
The problem I saw is that County Care, at least by January 2014, did not have an accurate referral listing, and so a primary care physician’s office may refer a patient to a specialist who doesn’t actually take County Care. Even though the referrals might be generated using County Care’s own Provider Portal, and approvals might be generated through the Provider Portal, the referral could still be to a doctor that doesn’t take County Care and doesn’t know why his or her name even showed up in County Care’s system. If a patient was to try to use the inaccurate referral, it’s likely that they would either be turned away by the specialist’s office or would end up with a medical bill.
The main way to avoid this problem, in a non-emergency situation, is to simply call and ask the specialist if s/he takes County Care before you make an appointment with them. If it turns out that your primary care physician incorrectly referred you to a specialist who doesn’t take County Care, then you’ll need to call your doctor back to let him or her know that you need another referral. You can also search for specialists yourself using this link: http://countycare.com/providers/providersearch.aspx
If you’re still having trouble finding a specialist that takes County Care, you may need to call County Care directly:
Phone: 312-864-8200 or toll free 1-855-444-1661
Hours: 8am-8pm Monday-Friday and 9am-2pm Saturday and closed Sunday
However, only your doctor can make the referral. County Care can only tell you who may be covered; they cannot make the approval by phone. In addition, they are unable to tell you if a referral went through or not. For that, you’ll need to call the specialist, to make sure that they do take County Care and that the referral went through okay. Even then, there may be specialists who are covered by County Care, but aren’t listed properly on the County Care referral website. For example, Planned Parenthood, the organization, shows up as only taking County Care for women’s reproductive services. However, they actually accept male patients with County Care health insurance as well.
Overall, be prepared to ask a lot of questions and to take a lot of notes if you want to avoid being charged for a service that County Care doesn’t cover.
Enlightening the Darkness 