Tessa Quinn
Common Ground Healthcare Cooperative (CGHC) is a healthcare provider with a strong reputation for member-focused service and a wide network of providers on the eastern side of Wisconsin. CGHC offers its members access to over 2500 providers and up-to-date drug and pharmacy information. Members do not need a referral to see a specialist or a provider in the Cooperative's network. In the event of an emergency, CGHC will cover out-of-network expenses for serious emergency care up to a certain amount, although it is always more cost-effective to use an in-network provider where possible.
| Characteristics | Values |
|---|---|
| Name | Common Ground Healthcare Cooperative |
| Type | Exclusive Provider Organization (EPO) network |
| Provider Network | 15,000+ providers in Wisconsin |
| Member Tools | Member Health Portal |
| Referrals | Not needed to see a provider in the network |
| Emergency Care | Covered out-of-network up to the maximum allowed amount |
| Pharmacy | Up-to-date drug and pharmacy information |
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What You'll Learn
- In-network emergency rooms are the most cost-effective option
- CGHC covers out-of-network expenses for serious emergency care
- No referral needed to see a specialist or in-network provider
- Access to over 2500 providers and up-to-date pharmacy information
- CGHC has a strong reputation for member-focused service
In-network emergency rooms are the most cost-effective option
Out-of-network ground ambulance services are also not covered by billing protections and can result in unexpected out-of-network bills. Urgent care clinics, while often out-of-network, present lower out-of-pocket expenses and are a more cost-effective option for non-life-threatening issues. These clinics have lower operational costs and simpler billing codes, resulting in lower overall charges.
In summary, while emergency rooms are equipped to handle severe and life-threatening conditions, they can be costly. In-network emergency rooms provide the benefit of billing protection, reducing the financial burden on patients. Therefore, it is always recommended to opt for an in-network emergency room whenever possible to ensure cost-effectiveness. CGHC also encourages members to utilize in-network emergency rooms to minimize out-of-pocket expenses.
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CGHC covers out-of-network expenses for serious emergency care
In the event of a serious or life-threatening emergency, Common Ground Healthcare Cooperative (CGHC) members should seek care at the nearest emergency room, regardless of whether it is in-network or out-of-network. CGHC understands that during an emergency, members may not always be able to access an in-network emergency room. Therefore, CGHC will cover out-of-network expenses for serious emergency care up to the maximum allowed amount. This will help reduce any out-of-pocket expenses for members who receive care at an out-of-network facility.
It is important to remember that emergency care should only be used when absolutely necessary. Emergency care is intended for situations where an individual is experiencing a life-threatening illness or injury. Some examples of situations that warrant emergency care include uncontrollable bleeding, severe head trauma, severe bone breaks, convulsions or seizures, moderate to severe burns, symptoms of a heart attack or stroke, and a very high persistent fever. When in doubt, consider whether the medical concern is life-threatening and seek emergency care if necessary.
While CGHC will cover out-of-network expenses for serious emergency care, it is always more cost-effective to utilise an in-network emergency room whenever possible. In addition, once the emergency has passed and the individual is stable, it is important to transition to an in-network facility for follow-up care. This ensures that the services received will be covered by the member's benefits, including deductibles, coinsurance, and copayments.
CGHC members should also be aware that there may be additional costs associated with out-of-network emergency care. In some cases, the out-of-network provider may bill the member for the difference between what they charge and CGHC's maximum allowable fee for the service. Therefore, it is important for members to understand their benefits and coverage before seeking emergency care. By understanding their coverage, members can make more informed decisions and potentially reduce their out-of-pocket expenses.
In summary, CGHC prioritises the well-being of its members and recognises the importance of timely and accessible emergency care. By covering out-of-network expenses for serious emergency care, CGHC ensures that members can seek the care they need without worrying about being limited to in-network facilities. However, to minimise out-of-pocket expenses, members are encouraged to utilise in-network emergency rooms whenever feasible and to transition to in-network facilities for follow-up care once the emergency situation has stabilised.
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No referral needed to see a specialist or in-network provider
Common Ground Healthcare Cooperative (CGHC) is an Exclusive Provider Organization (EPO). As such, CGHC members do not need a referral to see a specialist or in-network provider.
Generally, EPO members do not need to select a primary care physician (PCP) and do not need referrals to see other providers in the network. EPOs offer more flexibility than Health Maintenance Organization (HMO) plans, which usually require members to select a PCP who manages the patient's healthcare details and provides referrals for any other necessary services or specialist visits.
However, it is important to note that EPO plans tend to be more expensive than HMOs with otherwise comparable benefits. Additionally, while EPOs do not require referrals, members must still receive care from providers within the plan's network. Out-of-network care is typically only covered in emergency situations or when receiving care from an out-of-network provider at an in-network facility.
In the case of CGHC, while members do not need a referral to see a specialist, it is always most cost-effective to go to an in-network emergency room whenever possible. CGHC will cover out-of-network expenses for serious emergency care up to a maximum allowed amount to lessen any out-of-pocket expenses for members.
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Access to over 2500 providers and up-to-date pharmacy information
As a Common Ground Healthcare Cooperative member, you gain access to over 2500 healthcare providers through the Envision Network. This expansive network ensures that you can readily connect with a diverse range of healthcare professionals to meet your specific needs. Whether you require primary care, specialist consultations, or emergency services, you can conveniently access a broad spectrum of providers within the Common Ground Healthcare network.
In addition to this extensive provider network, Common Ground Healthcare also offers up-to-date drug and pharmacy information. This service empowers you to make well-informed decisions regarding your pharmacy benefits. By staying abreast of the latest pharmacy information, you can maximise your benefits and optimise your medication choices. This feature underscores Common Ground Healthcare's commitment to ensuring that its members have the resources necessary to make informed healthcare decisions.
The Exclusive Provider Organization (EPO) network that underpins all CGHC plans eliminates the need for referrals when seeing a specialist. This streamlined approach empowers you to seek specialised care without bureaucratic hurdles, simplifying the process of accessing the care you require. This feature is particularly advantageous when time is of the essence and expedites your journey towards receiving timely treatment.
In the event of a medical emergency, it is important to remember that emergency care should be sought in a hospital's emergency department. CGHC recognises that during emergencies, members might not always have the option to choose an in-network emergency room. In such situations, CGHC provides coverage for out-of-network expenses for serious emergency care, up to the maximum allowed amount. This safeguard helps alleviate potential financial burdens associated with out-of-pocket expenses when utilising out-of-network facilities in urgent situations. Nevertheless, it is worth noting that visiting an in-network emergency room remains the most cost-effective option whenever feasible.
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CGHC has a strong reputation for member-focused service
Common Ground Healthcare Cooperative (CGHC) has a strong reputation for member-focused services. CGHC has an expansive network on the eastern side of Wisconsin, with a provider network of 15,000+ providers. This extensive network ensures that members have convenient access to a wide range of healthcare services. CGHC's two cooperatives work together seamlessly to provide the highest quality experience and care to their members.
One of the key advantages of being a CGHC member is that no referral is needed to see a provider within the Cooperative's network. This includes primary care providers and specialists. This feature simplifies the process of accessing healthcare and saves time for members, as they can directly schedule appointments with the healthcare provider they need without having to go through a referral process.
CGHC also offers an up-to-date Member Health Portal, which provides valuable resources and tools for members to manage their health and engage with their healthcare journey. Through the portal, members can access their health records, connect with healthcare providers, and utilise resources such as up-to-date drug and pharmacy information to make informed decisions about their pharmacy benefits.
In addition, CGHC recognises the importance of emergency care and understands that during an emergency, members may not always be able to reach an in-network emergency room. To support its members in such situations, CGHC provides coverage for out-of-network expenses incurred during serious emergency care, up to the maximum allowed amount. This ensures that members can focus on receiving the urgent care they need without worrying about excessive out-of-pocket expenses.
Overall, CGHC's member-focused services are designed to provide its members with a seamless, accessible, and high-quality healthcare experience. With its extensive provider network, streamlined referral process, useful online tools, and emergency care coverage, CGHC demonstrates its commitment to ensuring that members can easily access the care they need, when they need it.
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Frequently asked questions
Common Ground Healthcare Cooperative is a healthcare provider with a strong reputation for member-focused service and an expansive network on the Eastern side of Wisconsin. It offers up-to-date drug and pharmacy information, helping members make the most of their pharmacy benefits.
No, you do not need a referral to see a specialist in the network. All CGHC plans have an Exclusive Provider Organization (EPO) network, so members can see a specialist without a referral.
You can access the provider directory at group-health.com or use the direct path at group-health.com/members/find-a-doctor. Choose "Members" and then "Find a Doctor." In the drop-down menu under "Select A Plan," choose State of WI (ETF) Common Ground.
In the case of an emergency, CGHC will cover out-of-network expenses for serious emergency care up to the maximum allowed amount. However, it is always more cost-effective to go to an in-network emergency room whenever possible.
