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

The Alliance

Beech Street / PPO Next PPO (Advocate Physician Partner Plan)

*Limited to providers listed below

Blue Cross Blue Shield

  • PPO
  • HMO Site:
    • Centegra #471 (Crystal Lake only)
    • Physician Care Network #98
    • Mercy #459 (Crystal Lake 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

Cofinity PPO (Advocate Physician Partners Plan)

*Limited to Providers listed below

Corvel

*Workers’ Comp Only

Coventry

  • Commercial – HMO, PPO, POS
  • Medicare Replacement – HMO, PPO

ECOH

First Health PPO

Health Alliance Medical Plan

  • Commercial
  • Medicare Replacement

Healthlink

  • State of Illinois plan

Healthlink / Unicare PPO

*Limited to providers listed below

HFN

  • Commercial – PPO
  • Workers’ Compensation

HST Care Connect (Advocate Physician Partners Plan)

*Limited to providers listed below

Humana Advocate Centered HMO Plan (Advocate Physician Partners Plan)

*Limited to providers listed below

Humana/Choice Care

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

PHCS/Multiplan –

*PHCS must be primary network

Quartz ASO

  • Swedish American Health System Employees or Dependents Only
  • Fully insured or self-insured groups effective 7/1/2018
  • Medicare Advantage effective 7/1/2018

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

United Harken Health ChoicePlus (Advocate Physician Partners Plan)

*Limited to providers listed below

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
  • Meridian Health Plan (Managed Medicaid & Medicare Replacement)
  • WI Public Health / Forward Health

*Participating providers in indicated insurance networks:

  • Michael Berkson, MD
  • Frank Bohnenkamp, MD
  • Richard Broderick, MD
  • Scott Ferry, MD
  • Rolando Izquierdo, MD
  • Jeffrey Kazaglis, MD
  • Scott Mox, MD
  • Jon Whitehurst, MD
  • Kevin Carlile, MD
  • Brian Foster, MD
  • Kenneth Korcek, MD
  • Jeffrey Earhart, MD
  • Geoffrey Van Thiel, MD
  • Kelly Holtkamp, MD
  • Kara Joyner, PA-C
  • Francois Kelso, PA-C
  • Joseph Maroney, PA-C
  • Valerie McCannon, PA-C
  • John Moore, PA-C
  • Stephanie Pease, PA-C
  • Marie Rivers, PA-C
  • Silvia Yung, PA-C
  • Sabrina Miller, 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 ASO

  • SwedishAmerican Health System Employees or Dependents
  • Full insured or self-insured groups effective 7/1/2018
  • Medicare Advantage effective 7/1/2018

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

Corvel (workers’ comp only)

Coventry

  • Commercial – HMO, PPO, POS
  • Medicare Replacement – HMO, PPO

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 ASO

  • 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)
  • Meridian Health Plan (Managed Medicaid and Medicare Replacement)
  • Illinois Department of Public Aid