Insurance and Referrals

Our practice participates in many managed care plans. We also see patients with traditional insurance. These are the specific plans that we participate in:

Aetna
Blue Cross Blue Shield of Illinois
CCN
Cherry Electric
Cigna
Epiqual
First Health Network
Foremost PPO
Group Administrators
Health Network
Health Payors Organization
Healthstar
HFN
Humana
Medview
Multiplan
ONE Health Plan of Illinois
Oxford PPO
Preferred Plan PPO
Private Health Care Systems
United Health Care
USA HealthNetwork PPO

Please note that this list may change from time to time, so please call us if you have any questions.

Many plans require that you make a co-payment at the time of your visit. For your convenience, we accept cash, checks and most major credit cards at our offices.

Some insurance plans may also require that you get authorization from them before you visit us. Since this differs by plan, please check with your insurance company so you can receive complete benefits from your coverage. We also have trained in-house specialists who can answer many of your insurance questions.

Please also be prepared with your card and co-pay at the time of your visit.

Referral Guidelines

We understand that insurance plan requirements can be complicated and confusing. Therefore, we have developed these basic guidelines to help you understand general insurance plan policies and responsibilities of patients and physicians. Please contact your customer service representative at your insurance company if you have any questions about your coverage or benefits.

Please note: Most insurance plans require patients to call their primary care physician (PCP) prior to going to an emergency room or urgent care center for treatment. If you choose to go on your own without your PCP's prior approval, coverage for the care rendered to you or your family at that location may be denied.

In life threatening situations it is not necessary to first call your PCP. You should be provided with information by your insurance company as to what is considered a "life threatening emergency". Please go to the emergency room nearest you (note: possible broken bones or stitches are not considered to be life threatening, so please call us first).

Please leave a message with one of the nurses at the office where your child is seen if you have any questions or requests for specialists, hospitals, or specialty referrals.

When Your Physician Has Authorized a Referral

It may take up to 2 weeks for us to obtain referral authorization from your insurance company. When your referral is ready, we will mail you a copy or notify you that it has been completed. Emergency situations will be attended to first. If you have not heard from us within a reasonable amount of time, please call. Please bring the referral copy mailed to you to your specialist appointment.

Managed care plans require the patient to obtain a referral PRIOR to seeing a specialty physician or receiving hospital tests and other services. Most insurance companies will not allow us to give a referral retroactively. If a referral is not secured PRIOR to the service being performed:

A. You must reschedule your specialist appointment, procedure or surgery; or

B. Your insurance plan may consider the work "non-referred / out of network" and reduce the benefits you are able to receive and / or you may be required to assume full financial responsibility.

If you see a specialist physician and he / she orders tests, recommends follow-up visits or any procedures for your child that was not included on the original referral, the insurance company will require a new referral. Please contact our referral coordinator. Also ask your specialist to fax a written evaluation of you child's condition so we can request a new referral authorization from your insurance company.