Payment Policies

Please click this link to read about our credit card policy: Payment Policy

Please bring your insurance card(s) with you to each appointment. You must inform us if your insurance or personal information has changed. You are also responsible to notify us if the cause for treatment is due to an accident or injury that has occurred outside of your home.

Payment is due at the time of service. We accept cash, personal checks (returned check fee $35), and credit cards (VISA and MasterCard). Deductibles, co-pays and fees for non-covered services are due at the time of service, unless prior arrangements have been made.

Your insurance policy is basically a contract between you and your insurance company. Our billing company will file your insurance claim if you assign the benefits to the doctor, i.e., if you agree to have your insurance company pay the doctor directly. If your insurance company does not pay the practice within a reasonable period, our billing company will have to look to you for payment. You are ultimately responsible for timely payment of your account.

We have made prior arrangements with many insurance companies to accept an assignment of benefits. Our billing company will bill them, and you are required to make any required co-payment amounts, as well as pay for any charges assigned to your deductible, or non-covered services.

If you are insured by a plan with which we do not have a prior arrangement, our billing company will prepare and send the claim for you on an unassigned basis. This means the insurer will send the payment directly to you. Therefore, our charges for your care are due at the time of service.

Not all insurance plans cover all services. In the event your insurance 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 billing company.

In self-pay cases, patients will be required to sign a Self-Pay Contract, as well as pay a deposit, as outlined in the Contract. No elective surgeries will be scheduled until these requirements are met. Only if a patient pays in full in advance of surgery, or in emergent cases (as deemed by the patient’s surgeon) will a signed contract be unnecessary for surgery scheduling.

Parents are responsible for medical expenses for their minor children, even if they have not signed for responsibility of the medical expenses. Either parent or both can be held responsible for medical bills. Custody of the children has no effect on responsibility for payment of medical bills.

Any patient that cancels a procedure with less than 72 hours’ notice or fails to show up for a scheduled procedure will be charged a fee of $150 to cover our pre-surgical expenses . This fee is not covered by insurance and is not eligible for payment plan arrangements or charity care.

Based on the merits of your case and your financial situation, charity care is available. If you have no insurance, your benefits have been maximized, or have a large deductible, but are not eligible for Public Assistance or Medicaid, please ask to speak to the office manager. You will need to provide a copy of last year’s tax returns and current paycheck stub to be considered for assistance.

Parents are responsible for medical expenses for their minor children, even if they have not signed for responsibility of the medical expenses. Either parent or both can be held responsible for medical bills. Custody of the children has no effect on responsibility for payment of medical bills.

Patients may incur additional charges not covered by insurance for services like photocopying and filling out of forms. While we are happy to provide this service, it makes a significant impact on our practice resources. In accordance with Illinois law, we charge:

• $15 for filling out of forms for employers, disability, etc.
• For photocopying, we charge:
  • $0.97 per page (pages 1-25)
  • $0.65 per page (pages 26-50)
  • $.32 per page (over 50 pages)

The State of Illinois allows a Handling Charge of $25.99 in addition to the above per-page fees, however, we will waive this fee as a service to our patients.

Accounts over 120 days past due or any accounts in violation of a written payment agreement will be turned over to a collection agency regardless of insurance coverage. Additionally, if sent to collections, you may be charged a collection fee of 25% of the total owed, as well as for all attorney fees, and court costs incurred by the creditor.