What Is My Insurance Coverage?

Insurance coverage is an arrangement between you and your insurance company, and/or your employer and your insurance company. Depending on your plan, it may not provide full payment of your medical costs. We have arrangements with many insurance companies, but there are many variances with each one, even with companies that have the same name. We will attempt to clarify policies as we understand them, but the ultimate responsibility remains with you. Our primary relationship is with you, and our goal is to provide the best possible orthopaedic care.

Do I Need A Referral?

If you are a member of an HMO, you will need a referral authorization from your primary care physician. If we have not received an authorization prior to your arrival at the office, we have a telephone available for you to call your primary care physician. We can attempt to facilitate this process; but we cannot guarantee payment if a referral is not available. If you are unable to obtain the referral at that time, you may be rescheduled or asked to pay the charges for the visit.

With Which Plans Do You Participate?

We participate with numerous major carriers such as Caterpillar, OSF HealthPlans, First Choice, Health Plus, Medicare, Tricare and the Illinois Department of Public Aid. We also participate with many national plans. Please contact your insurance carrier with questions.

What Is My Financial Responsibility for Services?

Your financial responsibility is determined by your insurance coverage.

How May I Pay?

We accept payment by cash, check, VISA and MasterCard.

What if My Physician Recommends Surgery?

If your physician recommends surgery, one of our Surgery Coordinators will answer specific questions about the surgery scheduling process, discuss the paperwork and tests involved, and if your insurance company requires it, begin the pre-certification/authorization process. The Surgery Coordinator will provide you an estimated cost of the procedure. You may visit with one of our business office staff to discuss payment options for costs not covered by your insurance company. We may request a pre-surgical deposit, the amount of which depends on your coverage and deductible amount.

What if My Child Needs to See the Physician?

On the first visit of a patient who is a minor, the patient must be accompanied by a parent or legal guardian. This adult is responsible for payment of the account, according to the policy outlined in this document.