Other Billing Services
These services include any claim that is not billed to the patient’s regular health insurance.
The patient must inform every medical provider (office visit, x-ray, lab, etc.) that the service they are receiving that day is related to one of the categories listed below. This notification helps to ensure that the appropriate insurance carrier (not the patient's health insurance) is billed for these services. The patient should receive a copy of the Special Billing form to be completed with each visit. Our Special Billing form can be filled out before each visit electronically, printed and saved to your personal computer as needed. Otherwise the form can be filled out at the time of your appointment.
Personal Liability
The patient will be required to complete a Special Billing form at the time of service and must provide the date of accident, where the injury took place and how the injury occurred. Billing information will need to include name and address of the party responsible for payment of claim.
Motor Vehicle Accident
Be prepared to give insurance information of the auto insurance responsible for paying the claims along with address and name of the insurance agent. Other important information will be required including date of accident and where and how the accident occurred.
Worker’s Compensation
Be prepared to give insurance information of the auto insurance responsible for paying the claims along with the address and name of the insurance agent. Other important information will be required including date of accident and where and how the accident occurred.
Illinois Healthy Women
The Illinois Healthy Women’s pink card must be presented at the time of service.
If you have an Illinois Healthy Womens’ card, the services will be covered only if they relate to family planning (birth control) or reproductive health services. Otherwise, the visit is not covered by the Illinois Healthy Women’s program.
Illinois Breast-Cervical Cancer Program (IBCCP)
The appointment to see a provider is made by IBCCP. The patient will need to remind the office at time of service that they are an IBCCP patient in order for claims to be processed through this program.