Mask Mandate Remains in Place for Health Care Settings

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 Replacement – HMO, PPO, POS

ClaimDOCs

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

The Alliance

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
  • Medicare Complete
  • Wellcare 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:

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

Claim Docs

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 Select (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)

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