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Participating Insurance Plans

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 Advantage – HMO, PPO, POS

The Alliance

Blue Cross Blue Shield

  • Choice
  • PPO
  • HMO Site:
    • Advocate
    • AMITA
    • Northwestern
    • Physician Care Network #098

Cigna

  • Open Access PPO Plans

Claim Doc

Corvel (Workers’ Compensation Only)

Coventry (Workers’ Compensation Only)

Dean Healthcare (Winnebago & Boone Counties Only)

Dean Advantage (Winnebago & Boone Counties Only)

ECOH

First Health PPO

  • Commercial
  • Medicare Advantage

Health Alliance Medical Plan

  • Commercial
  • Medicare Advantage

Healthlink

  • State of Illinois plan

HFN

  • Commercial – PPO
  • Workers’ Compensation

Humana/Choice Care

  • Commercial – EPO, HMO, POS
  • Medicare Advantage – HMO, PPO, POS

PHCS/Multiplan –

*PHCS must be primary network

Provider Network of America

Quartz

  • Excludes State UW Plan – Dane County Members

Trilogy Workers Compensation

United HealthCare

  • Commercial – EPO, HMO, PPO, POS
  • Medicare Advantage – PPO, AARP Medicare Complete
  • VA CCN – Veterans

Government Plans

  • Medicare
  • Clear Springs Medicare Advantage
  • Illinois Department of Public Aid
  • WI Public Health / Forward Health
  • Zing Medicare Advantage

*Participating providers in Advocate Physician Partners (APP) plans:

  • Amrit, Anand, MD
  • Frank Bohnenkamp, MD
  • Robert Bohnenstiehl, APRN
  • Kevin Carlile, MD
  • Jeffrey Earhart, MD
  • Christopher Faubel, MD
  • Scott Ferry, MD
  • Michael Finigan, PA-C
  • Brian Foster, MD
  • Kristian Green, PA-C
  • Michael Harvey, MD
  • Rolando Izquierdo, MD
  • Jacqueline Kannan, MD
  • Jeffrey Kazaglis, MD
  • Francois Kelso, PA-C
  • Amanda Kroymann, PA-C
  • Donald Kuick, PA-C
  • Cort Lawton, MD
  • Stephanie Leverentz, PA-C
  • Valerie McCannon, PA-C
  • Sabrina Miller, PA-C
  • John Moore, PA-C
  • Scott Mox, MD
  • Shawn Palmer, DO
  • Pradeep Raju, MD
  • Marie Rivers, PA-C
  • Trevor Schott, MD
  • Husna Siddiqui, MD
  • Tom Stanley, MD
  • Geoffrey Van Thiel, MD
  • Jon Whitehurst, MD
  • Marc A. Zussman, MD

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

Claim Docs

Corvel Workers’ Compensation

Coventry

  • Commercial – PPO, POS

ECOH

First Health PPO

Health Alliance Medical Plan

HFN

Humana/ChoiceCare

  • Commercial – PPO, POS

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 Better Health
  • 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 Community Family Health
  • Harmony Health Plan
  • Illinicare Health Plan
  • Illinois Public Aid
  • Meridian Health Plan
  • 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)

ClaimDOCs

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
  • Medicare Complete
  • Wellcare Medicare
  • Community Care Alliance of Illinois (Medicare Replacement)
  • Illinois Department of Public Aid