Financial Policy and Procedures – Clinic and Rehabilitation Center
The physicians and staff at Ortho Illinois 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.
Sincerely, Ortho Illinois
If you have any questions in regards to our policies or an account, please do not hesitate to contact our office at (815) 398-9491. Our business hours are 8:00 a.m. – 5:00 p.m., C.S.T. Monday through Friday.
Payments can be made using cash, check, money order, Visa, Master Card, American Express, or Discover. Options for any patient balance greater than $100 are listed on our payment policy guidelines. For a copy, please contact our A/R department at 815-398-9491.
PATIENTS WITH EMPLOYMENT INJURIES
Ortho Illinois will bill any Workers’ Compensation insurance carrier or employer providing prior authorization. We are unable to schedule patient appointments under any of the following circumstances:
- There is no prior approval from the Workers Compensation insurance carrier or employer
- The Workers’ Compensation claim is disputed or denied
- The patient is in the process of filing a Workers’ Compensation claim
- The patient is considering filing a Workers’ Compensation claim
Patients should notify our office to discuss setting up an appointment once a Workers’ Compensation carrier has authorized payment for treatment or the issue has been determined by the Illinois Workers’ Compensation Commission.
If a Workers’ Compensation carrier denies further authorization for patients already undergoing treatment, it will then be the patient’s responsibility to contact their health insurance carrier and receive approval for any further treatment in writing.
Falsification of information provided by patients may result in discharge from our practice.
PATIENTS WITH LIABILITY OR AUTO ACCIDENT INJURIES
Liability insurance information must be given at the time of service. If an attorney is involved you will be responsible for providing us with their name, address, and phone number. We will bill your liability insurance carrier as the primary payer. Once the liability insurance has maxed, the patient’s health insurance will be billed.
As a courtesy to our patients, we will bill the Third Party Carrier, but the patient is ultimately responsible for payment of services.
Any balance remaining after 30 days will be the patient’s responsibility.
PATIENTS WITHOUT MEDICAL INSURANCE
Payment in full is expected at the time of service unless prior arrangements have been made with our financial counselor.
PATIENTS RECEIVING ILLINOIS PUBLIC AID
You are required to bring your current state issued Medicaid card at the time of service. We will then submit your medical claims. If you do not have your card or you have an unmet spend down, you will be responsible to pay for any services at the time of treatment.
It is the patient’s responsibility to contact their insurance carrier to verify that Ortho Illinois is contracted with them. If a referral is required, it is your responsibility to contact your primary care physician before your appointment. We reserve the right to reschedule any appointment if all required information is not received prior to your appointment.
PATIENTS COVERED UNDER CONTRACTED INSURANCES WITH ORTHO ILLINOIS
All co-pays and deductibles are due at the time of service, or your appointment may be rescheduled. If payment is not made, a dated return envelope will be given to you to remit payment within 5 business days. If payment is not received within the days allowed, a $20.00 billing fee will be charged to your account. We will bill all services to the appropriate insurance carrier. Any co- insurance or unpaid balances are to be paid in full unless prior arrangements have been made with the billing department.
PATIENTS COVERED UNDER NON-CONTRACTED OR COMMERCIAL INSURANCES
All deductibles are due at the time of service, or your appointment may be rescheduled. If payment is not made, a dated return envelope will be given to you to remit payment within 5 business days. If payment is not received within the days allowed, a $20.00 billing fee will be charged to your account. We will bill all services to the appropriate insurance carrier. Any co-insurance, over usual and customary, or unpaid balances are to be paid in full unless prior arrangements have been made with the billing department.
If an insurance company has indicated a charge is above usual, please understand this only means it is above their allowable rate. We want to assure you that our charges reflect the complexity of care given and the skill and expertise required for your care. We use many sources to determine the appropriateness of our charges, and cannot have insurance companies setting our fees. If you have any questions in regard to ‘usual and customary’, please contact your insurance carrier.
PATIENTS WITH ACCOUNT COLLECTION BALANCES
New condition/injury appointments will not be scheduled for patients with an outstanding collection balance. If an 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.
PRIVATE/GROUP HEALTH INSURANCE
We participate with various group health insurance plans. Please contact your insurance to verify Ortho Illinois as participating providers. It is our policy to confirm the eligibility and benefits of all of our patients and inform them of the particulars of their insurance coverage for therapy at the time of their first visit. We also work with the patient’s doctor and insurance company to obtain authorization for therapy when it is required.
We are happy to check your eligibility and benefits. You must supply us with a copy of your insurance card(s).
We provide insurance billing services for our patients on a daily basis. Any balance due after the patient’s insurance has paid, such as coinsurance and/or deductible amounts, is billed to the patient on a monthly basis. Co-payments are collected at the time of each visit.
We accept insurance for all Medicare recipients. We will provide billing to both Medicare and your secondary or supplemental insurance if you should participate in one. If you do not have a secondary or supplemental insurance you will have a 20% co-pay on the allowable amount accepted by Medicare.
Patients who are involved in a motor vehicle accident are required to use their automobile insurance if there is “Medical Pay” included in their policy. These amounts generally range from $1,000.00 to $20,000.00 depending on the policy and our clinic will bill the patient’s insurance up to the amount of Medical Pay included in their policy.
Injured workers have 100% coverage for accepted claims through their employer’s worker’s compensation insurance. Due to workers’ compensation regulations legislated by the Illinois State Assembly, prior authorization for therapy may be required before the patient can begin therapy. We work with the patient’s doctor and workers compensation adjustor to obtain authorizations in as timely a fashion as possible.
For patients without insurance, we have affordable payment options available. We accept payments by cash, check, MasterCard, Visa Debit and Credit Card, Discover Card, and American Express.
ORTHO ILLINOIS INSURANCE SPECIALISTS
Patients who have specific questions regarding therapy authorization are welcome to contact the billing department at Ortho Illinois at 815-484-6991 to receive further clarification on benefit levels and coverage.
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.