Participating Insurance Plans
Insurance Information
Ortho Illinois participates with most national and local insurance plans. It is the responsibility of you, the patient, to understand your insurance policy, benefits and limitations. We highly encourage you to contact your insurance provider at the phone number on the back of your card to verify Ortho Illinois is in-network for your plan. As a courtesy to you, we will file a claim with your insurance company for benefits. Updated insurance information is required at the time of your visit. If you do not provide us with a current/active insurance card Ortho Illinois will ask you to reschedule your appointment. Based on your coverage, you will be responsible for any co-payments, co-insurance, out-of-network, or other amounts due.
Insurance and Patient Responsibility
- Please understand that insurance coverage is an arrangement between you and your insurance company, and that your insurance company may not provide full payment of your medical costs.
- Prior to making an appointment, check with your carrier to verify we participate in your plan.
- If your insurance plan requires you to obtain a referral from your primary care physician, it is your responsibility to obtain this referral prior to your scheduled appointment.
- If your insurance plan requires a co-payment, this payment is expected at the time of service.
- If you are scheduled for diagnostic testing or surgery, please check with your insurance company to determine if it requires you to obtain a pre-authorization or second opinion.
Aetna
- Commercial HMO, PPO, POS
- Aetna – State of Illinois
- Medicare Replacement – HMO, PPO, POS
The Alliance
Beech Street / PPO Next PPO (Advocate Physician Partner Plan)
*Limited to providers listed below
Blue Cross Blue Shield
- PPO
- HMO Site:
- Site 471, 487, 489, 475, 477, 493 – Northwestern (Select providers only)
- Site 474 – Advocate Sherman (Select providers only)
- Site 600 – Advocate Blue Care Direct (Select providers only)
- Site 098 – Physician Care Network
- Site 459 – Mercy (Select providers only)
- Medicare Advantage HMO
- Site 757 – Northwestern (Select providers only)
- Site 742 – Advocate (Select providers only)
Blue Cross Blue Shield (Advocate Physician Partners Plan)
*Limited to providers listed below
- Blue Care Direct HMO (Marketplace/Exchange Plan) with a PCP referral only.
- Blue Precision HMO (Marketplace/Exchange Plan) with a PCP referral only.
- Blue Medicare Advantage Basic HMO with a PCP referral only.
- Blue Medicare Advantage Basic Plus HMO-POS with a PCP referral only.
- Blue Medicare Advantage Premier Plus HMO-POS with a PCP referral only.
Blue Cross Medicare Advantage PPO (Advocate Physician Partners Plan)
*Limited to providers listed below
- *Choice Plus PPO
- *Choice Premier PPO
Blue Cross Community MMAI HMO (Advocate Physician Partners Plan)
*Limited to providers listed below
- *Medicare-Medicaid
Cigna
- Open Access PPO Plans
Clear Spring Health
- Medicare Advantage
Corvel (Workers’ Compensation Only)
Coventry
- Commercial – HMO, PPO, POS
- Medicare Replacement – HMO, PPO
- Workers’ Compensation
ECOH
First Health PPO
Health Alliance Medical Plan
- Commercial
- Medicare Replacement
Health Alliance Employee EPO
*Limited to providers listed below
Healthlink
- State of Illinois plan
Healthlink / Unicare PPO (Advocate Physician Partners Plan)
*Limited to providers listed below
HFN
- Commercial – PPO
- Workers’ Compensation
HST Care Connect (Advocate Physician Partners Plan)
*Limited to providers listed below
Humana/Choice Care
- Commercial – EPO, HMO, POS
- Medicare Replacement – HMO, PPO, POS
Meridian Medicaid (Advocate Partners Plan)
*Limited to providers listed below
OSF Direct Access Network (Select providers only)
PHCS/Multiplan –
*PHCS must be primary network
Quartz Health ASO and HMO
- Swedish American Health System Employees or Dependents
- Fully insured or self-insured groups effective 7/1/2018
- Medicare Advantage effective 7/1/2018
- Quartz HMO plans do not require referrals
SEIU – Local 4 HMO & PPO (Advocate Physician Partners Plan)
*Limited to providers listed below
Trilogy Workers Compensation
UIC Campus Care
*(Must have referral from University of Illinois)
Union Medical (Local 1546) HMO (Advocate Physician Partners Plan)
*Limited to providers listed below
Union Medical (Local 1546) HMO – (Advocate Physician Partners Plan)
United HealthCare
- Commercial – EPO, HMO, PPO, POS
- Medicare Replacement – PPO, AARP Medicare Complete
- VA CCN – Veterans
Government Plans
- Medicare
- Community Care Alliance of Illinois (Medicare Replacement)
- Illinois Department of Public Aid
- WI Public Health / Forward Health
*Participating providers in Advocate Physician Partners (APP) plans:
- Debdut Biswas, MD
- Frank Bohnenkamp, MD
- Brian Braaksma, MD
- Nicholas Brissey, DPM
- Richard Broderick, MD
- Kevin Carlile, MD
- Jeffrey Earhart, MD
- Christopher Faubel, MD
- Scott Ferry, MD
- Brian Foster, MD
- Kelly Holtkamp, MD
- Rolando Izquierdo, MD
- Jeffrey Kazaglis, MD
- Kenneth Korcek, MD
- Scott Mox, MD
- Shawn Palmer, DO
- Tom Stanley, MD
- Geoffrey Van Thiel, MD
- Jon Whitehurst, MD
- Valerie McCannon, PA-C
- Amy Erlenbusch, PA-C
- Michael Finigan, PA-C
- Kristian Green, PA-C
- Francois Kelso, PA-C
- Sabrina Miller, PA-C
- John Moore, PA-C
- Stephanie Pease, PA-C
- Marie Rivers, PA-C
- Subil Thomas, PA-C
- Silvia Yung, PA-C
Aetna
- Commercial – PPO, POS
The Alliance
Blue Cross Blue Shield
- PPO, Open Access, POS
- HMO: Physician Care Network #098 (only this specific site number)
Cigna
- Open Access PPO Plans
Corvel Workers’ Compensation
Coventry
- Commercial – PPO, POS
ECOH
First Health PPO
Health Alliance Medical Plan
HFN
Humana/ChoiceCare
- Commercial – PPO, POS
PHCS/Multiplan – PHCS must be primary network
Quartz Health ASO.HMO
- Swedish American Health System employees or dependents
- Fully insured or self-insured groups effective 7/1/2018
- Medicare Advantage effective 7/1/2018
- Quartz HMO plans do not require referrals
United Healthcare
- Commcercial – PPO, POS
- Medicare Advantage – PPO, AARP Medicare Complete
Government Plans
- Medicare
- Medicare Replacement Plans – PPO, POS, Open Access
* Not accepted at Injury Express: Self pay patients or the following insurances:
- Advocate Accountable Health
- Aetna Medicare Advantage
- Any BCBS HMO Plan except for site 098 (Physicians Care Network)
- Any HMO insurance plans that require a referral authorization from the PCP unless the authorization is brought to the appointment
- BCBS PPO Choice (BCS is in the right hand corner of the card)
- BCBS Community Family Health
- Coventry Total Care
- Harmony Health Plan
- Illinicare Health Plan
- Illinois Public Aid
- Meridian Health Plan
- Self-pay patients
- Tricare Prime
- UMR Health Smart Preferred
- United Healthcare Navigate
- Veterans Association
- Wisconsin Public Aid (BadgerCare)
Aetna
- Commercial – HMO, PPO, POS
- Aetna – State of Illinois
- Medicare Replacement – HMO, PPO, POS
The Alliance
Blue Cross Blue Shield
- PPO
- HMO: Physician Care Network #098 (only this site number)
Cigna
- Open Access PPO Plans
Clear Spring Health
- Medicare Advantage
Corvel (workers’ compensation only)
Coventry
- Commercial – HMO, PPO, POS
- Medicare Replacement – HMO, PPO
- Workers’ Compensation
ECOH
First Health PPO
Health Alliance Medical Plan
- Commercial
- Medicare Replacement
Healthlink
- State of Illinois
HFN
- Commercial – PPO
- Workers’ Compensation
Humana/Choice Care
- Commercial – EPO, HMO, POS
- Medicare Replacement – HMO, PPO, POS
PHCS/Multiplan –
PHCS must be primary network
Quartz Health ASO/HMO
- SwedishAmerican Health System Employees or Dependents – excluded from using OISC
- Fully insured or self-insured groups effective 7/1/2018
- Medicare Advantage effective 7/1/2018
Trilogy Workers’ Compensation
UIC Campus Care
must have referral from University of Illinois
United HealthCare
- Commercial – EPO, HMO, PPO, POS
- Medicare Replacement – PPO, AARP Medicare Complete
Government Plans
- Medicare
- Community Care Alliance of Illinois (Medicare Replacement)
- Illinois Department of Public Aid