815.477.0300 ::: 260 Congress Parkway Suite A, Crystal Lake, IL 60014

OB/GYN Policies & Insurance


 

Thank you for choosing us as your healthcare provider. The following is a statement of our Financial Policy, which we ask you to read prior to any treatment.

COPAYS ARE DUE AT THE TIME OF SERVICE, PRIOR TO SEEING THE DOCTOR.

If there is no insurance, payment in full is required at the time of service. All visits will be rescheduled if you are unable to pay in full or if prior arrangements have not been made.
CASH, CHECK OR VISA/MC ARE ACCEPTED

REFERRALS

Referrals required by certain HMO plans are the patient’s responsibility to have done prior to any treatment. Every person’s insurance plan is different and only you can be responsible for knowing your plan.  If the physician sends you for outside tests, and referrals are necessary, you must inform us and allow ample time to receive the referral prior to scheduled tests.

INSURANCE

There are many different plans that we participate with and although our staff is very knowledgeable of which plans we are with, it is ultimately up to you to know if we are a participating provider. We cannot bill your insurance company unless you give us your current insurance information. It is our policy to have a copy of your current card in our files in order to bill the insurance. If you do not have a card, you will be responsible to pay at the time of service. In plans where we are a participating provider, all co-pays and deductibles are due at the time of treatment. For out of network plans, we will bill your insurance, as a courtesy, but we do require that you pay in full at the time of service. Some services and perhaps all of the services provided may be non-covered services and not considered reasonable and necessary under your plan. The balance is your responsibility, whether your insurance company pays or not. It is your responsibility to inform us of double insurance coverage. If you have double insurance coverage it is your responsibility to know what policy is primary and which policy is secondary. If your insurance requires precertification prior to inpatient/outpatient stay, we will work with you, as a courtesy, in getting precertification done. Ultimately, it is your responsibility that it is done. If you are a college student and covered under your parents insurance, it is required that you fill out the student status verification form and send it to the insurance company each semester. If this is not done routinely, the insurance company will not pay the claims and you or your parent/guardian will be responsible for full payment. In all cases, if your insurance has not paid within 90 days, the balance will become the patient’s responsibility.

PAYMENT RESPONSIBILITY

Adult patients are responsible for payment of their own accounts. The adult accompanying a minor and/or the parents (or guardians of the minor) is responsible for payment of a minor patient’s charges. For unaccompanied minors, non-emergency treatment will be denied unless required paperwork is fully completed and all insurance information is complete. The adult accompanying the minor will be required to sign appropriate documents and assume responsibility if the parent/guardian who is the policy holder of the insurance is not available. We do not get involved in divorce/custody payment arrangements. The parent that accompanied the minor assumes responsibility under all circumstances.

MISSED APPOINTMENTS

Unless cancelled at least 24 hours in advance our policy is to charge a minimal fee for missing an appointment. Please help us serve you better by keeping scheduled appointments.

RETURNED CHECKS

Returned checks are subject to a $25.00 service charge.

We realize that temporary financial problems may affect timely payment of your account. If such problems do arise, we encourage you to contact us promptly for assistance in the management of your account. If you have any questions about the above information or any uncertainty regarding insurance coverage, please don’t hesitate to ask us. We are here to help you.