Financial Policy

Financial Policy

Financial Policy and Procedures  – Clinic and Rehabilitation Center

Dear Patient:

The physicians and staff at OrthoIllinois appreciate the opportunity to provide outstanding orthopedic medical care to the Northern Illinois area. It is our obligation to provide the most responsive and high quality care in a cost-effective manner. To assure continued community service, our facility strives to provide any financial resources available. As the patient, or the responsible person for medical charges, we have provided you this information to help you understand our financial policies. 

If you have questions regarding our policies or an account, please do not hesitate to contact our office at (815) 484-6991.  Our business hours are 8:00am – 4:30pm CST Monday through Friday.


 Your signature on OrthoIllinois’ Consent form authorizes the following:

  • I assign to OrthoIllinois all insurance benefits or Medicare benefits to which it may be entitled for services rendered by its providers and authorize direct payment to the practice. This assignment includes without limitation major medical and disability insurance proceeds and benefits accruing under any settlement, structured or otherwise, or awarded in judgment for personal injury caused by a third party. I agree to pay practice for all charges not paid pursuant to this assignment.
  • I authorize OrthoIllinois to release all pertinent medical information to my insurance carrier(s) or employer, in the case of a Workers Compensation claim, in order to process any and all claims.
  • I understand that I will be charged $25 if I cancel an appointment less than 24-hours before an appointment OR do not show for an appointment. My insurance will not be billed and I am fully responsible for these charges.  Exceptions to this policy may be granted at the discretion of OrthoIllinois.
  • I understand I will be charged a $25 fee for returned checks for any reason.
  • I understand that should my account be referred to a collection agency for collections I will be responsible for all collection fees of 25% in addition to the amount referred to collections.
  • If, after all your claims have been paid, the resulting balance is a credit of $5.00 or less, I authorize OrthoIllinois to write off this balance. Amounts greater than $5.00 will be refunded to me.

Financial Policy Expectations:

  • Please present your insurance card and photo ID at each appointment. Please share address, telephone number, email address, and/or insurance information updates any time a change occurs.
  • Payment of your deductible and coinsurance will be required for your calculated portion of our fees, based on our contract with your insurance, in advance of any scheduled surgical procedures and diagnostic testing. Any balance remaining after your health plan pays its portion is your responsibility and payment for balance is due upon notification from our office. Any overpayment will be refunded directly to you.
  • You may be asked to put a credit card on file, which will only be charged according to the terms you agree to when placing such card on file. By processing your insurance first, we will only charge you for your exact out-of-pocket responsibility.  You will receive notification containing a summary of charges and an estimate of what we believe you will owe.  After your insurance has processed your claim, you will receive a second notification informing you of the actual amount you owe and notifying you that your card will be charged.
  • New condition/injury appointments will not be scheduled for patients with an outstanding collection balance. If your account has been submitted for and is currently in collection, it must be brought up to good standing before a new appointment will be scheduled.
  • Your insurance is an agreement between you and your insurance company. As a courtesy to you, we will file your insurance claims for you if you assign benefits to the practice. If your insurance does not pay, we will look to you for payment of your balance in full.
  • All health plans are not the same and do not cover the same services. If your health plan determines a service to be “not covered”, you will be responsible for the complete charge. Payment is due upon receipt of a statement from our office. You are responsible for knowing and understanding your insurance benefits.
  • OrthoIllinois reserves the right to not accept or bill an insurance company that we are not contracted with.
  • You will be responsible for promptly responding to your insurance company to provide additional information they may request regarding your treatment, pre-existing conditions, accidents or other insurance coverage. Failure to respond in a timely manner may result in your account becoming due and payable, in full, by you.
  • If your insurance plan requires prior authorization or referral from your primary care physician for each visit, this is your responsibility. IF YOU DO NOT HAVE THIS REFERRAL NUMBER AT THE TIME OF YOUR APPOINTMENT,YOUR BENEFITS MAY BE PAID AT A REDUCED RATE OR NOT PAID AT ALL AND YOU WILL BE RESPONSIBLE FOR THE CHARGES.
  • When you are charged a “global” fee for surgery or office care of a fracture, laceration repair, or other medical procedure, that fee includes the service on the day it is performed and routine follow up care as well. The global period ranges from 10 to 90 days depending on the procedure and your health plan. Injections, X-rays, and supplies (such as casting or dressing materials, splints, braces, etc.) are not included in the “global” fee and a charge will be made for these items. Services related to complications are not included in the global fee.
  • There are no refunds or returns on braces and durable medical equipment. 

Workers Compensation Injuries:

  • OrthoIllinois will bill any Workers Compensation insurance carrier or employer providing prior authorization.
  • OrthoIllinois requires you to provide your group health insurance at time of scheduling regardless of the approval status of your Workers Compensation claim. In the event a service is provided and not covered under Workers Compensation, your group health insurance will be billed and you will be responsible for all deductibles, co-insurance, and copays.
  • If a Workers Compensation carrier denies further authorization for your ongoing care OrthoIllinois will bill your group health insurance carrier. If you do not have group health coverage or have insurance that OrthoIllinois doesn’t accept you will be personally responsible for the charges.
  • If your Workers Compensation claim is disputed and you have a case on file with the Illinois Workers Compensation Commission, OrthoIllinois will bill your group health and any remaining balance will be your responsibility once the case settles.

Liability, Auto Accident, and Personal Injury Injuries:

  • Liability insurance information must be given at time of scheduling. If an attorney is involved you will be responsible for providing us with their name, address, and phone number.  We will bill your liability carrier as the primary payer.  Once the liability insurance has maxed, your group health carrier will be billed and you will be responsible for all remaining charges.
  • If you have filed a third party liability claim, you are ultimately responsible for all charges. If your case is pending settlement, OrthoIllinois will require a minimum of $100/month payment to keep your account from being referred to collections.

Payment Options:

  • Payments can be made using cash, check, money order, Visa, Master Card, American Express, Discover, or Care Credit.
  • Payments are due at time of statement. If payment cannot be made in full please contact our patient financial counselors at (815) 484-6991 to set-up a formal payment plan. For long term payment plans OrthoIllinois partners with Care Credit to offer no interest and fixed interest payment terms to those who qualify.  If a formal payment plan is not established your account will be reviewed for collections.

Financial Policy and Procedures Surgery Center

It is important to familiarize yourself with your health insurance policy and know your deductible, co-pay, and policy limits. Ortho Illinois does not have access to your specific health insurance policy and is not able to provide you with the costs you may be responsible for prior to billing.

If you will be undergoing a procedure at our Surgery Center, we do offer financial counseling to help you understand the types of charges you may be subject to and how to contact your insurance carrier to understand your coverage and personal responsibilities. Below you will find a list of the participating insurance networks in which Ortho Illinois Surgery Center belongs.

Please note that any co-payment required by your insurance carrier is due, and must be paid, on the date of your surgery when you check-in. Non-payment may result in the re-scheduling of your appointment or a billing fee.

You may also be subject to separate charges from those applied by Ortho Illinois. For example, anesthesiology services are billed by and payable to the anesthesiologist directly.

Our Billing and Payment Procedures policy provides more detailed disclosure.

Here is additional information you should understand prior to receiving services at Ortho Illinois Surgery Center:

  • Our office participates in Medicare.
  • We will assist you in filling out insurance forms at no charge. We will also fill out non-medical insurance forms. However, a $10.00 charge is required with payment at the time of request.
  • It is your repsonsibility to make sure your health insurance company pays for services rendered. The contract is between you and your health insurance carrier.
  • If insurance benefits are paid directly to you, it becomes your obligation to forward them directly to us.
  • We require the assignment of insurance benefits to Ortho Illinois, for services we perform.
  • All elective surgical procedures must be approved by your insurance carrier prior to scheduling.
  • Ortho Illinois physicians are on staff or have privileges at the local hospitals as well as our own outpatient surgery center in Rockford, Rockford Ambulatory Surgery Center and Algonquin Road Surgery Center in Lake of the Hills.