Since the founding of our practice, we have always offered the best medical care possible. In order to continue to do so, we want to explain to you our payment policy .

In our practice, we expect payment at the time of service for patients who have no insurance coverage. For those patients who have coverage, we offer the courtesy of submitting charges to insurance, and we expect that any patient due portion will be paid in a timely manner. As a courtesy to you, we will file a claim with your primary and secondary plans. If you have a third or fourth plan, we will provide you with the papers necessary to file your own claims.

In order to make it easier for you, we accept cash, checks, money orders, VISA, MasterCard, and Discover for payment. All may be given as payment at the front desk or sent with your statement for payment of your balance.

If your visit involves Workers' Compensation, we must have written documentation from your employer verifying the workers' compensation status, along with specific information regarding the injury and insurance coverage. Without this documentation, payment for your visit will be your responsibility and we will bill your group health insurance plan for you.

We send monthly statements to inform you of any balances due, and we will also remind you of money due when you call to schedule an appointment and when we call to confirm appointments. We expect that patient due balances will be paid upon receipt of our statement, or at your next visit. If it becomes necessary to place your account with a collection agency, all costs of this process will be your responsibility.

While our billing professionals will do all they can to help you in communicating and negotiating with your insurance plan, we must inform you that any balance remaining on your account that is 60 days old will be considered your responsibility and billed to you.

Should a surgical procedure be necessary, we will help you communicate with your plan to learn of their payment responsibility, and then arrange a payment plan for your portion of the charges.

The next section outlines our policy in more detail for self-pay patients and patients with insurance, Medicare, Public Aid, or managed care plans.

If you have . . .	You are responsible for . . .	Our staff will . . .
"Regular" insurance or commercial insurance also known as indemnity insurance	Payment of balance remaining after insurance payment and/or any balance older than 60 days.	Answer any questions for you and fille an insurance claim to your primary and secondary insurance as a courtesy to you.
Managed Care plans with which we have a contract. See list at reception desk.	. Payment of all applicable copays and deductibles at the time of the office visit.	Answer any questions for you. File an insurance claim on your behalf.
Managed Care plans with which we have no contract	Payment in full for all services provided at the time of your office visit.	Provide information for you to complete and file your claim directly with your insurance company.
Medicare	Payment of balance of approved amount Payment of any services and supplies not covered by Medicare at time of your office visit.	File claims on your behalf to Medicare and your secondary or Medigap insurance.
Workers' Compensation	Providing our office with a completed Workers' Compensation Verification form including a claim number. If no verification form is completed, payment of $95 is due at the first visit.	File a claim to your insurance or employer on your behalf
Liability Insurance	Payment in full at the time of your office visit unless we have a fully completed Liability Claim Information form.	Bill your insurance if you provide information or provide you a receipt so you can file the claim with your carrier.
No Insurance	Payment of $95 for a new patient or patient with a new problem Payment in full at the time of your office visit	Work with you to settle your account. Please ask to speak with our staff if you need assistance.
Public Aid	Presenting our office with your current IPA card and a $2.00 payment before each visit if 18 or older and not pregnant. Payment of all medical supplies.	File a claim to Public Aid on your behalf.
NIU students	Providing us with all applicable insurance information and a referral from health service.	File a claim to your insurance on your behalf

We ask that you bring your insurance card(s) and your driver’s license with you to each and every visit made to our office. We offer you the courtesy of submitting your charges to both a primary and secondary plan. Furthermore, our professional, experienced staff deals with over 200 insurance plans and can help negotiate the complex maze of requirements. Familiarity with your own particular plan will minimize the potential for delays or unnecessary charges associated with your visit or surgery.

HMO plans, and some other plans, require that patients seen in our office bring a referral to each visit. Referrals are obtained from Primary Care Physicians and are the patient’s responsibility to provide. If your plan requires a referral, we cannot see you without it.