Billing & Insurance
General Billing Information
Carlson Orthopedic Clinic appreciates the opportunity to provide outstanding orthopaedic care to our patients. We are dedicated to providing the most responsive and highest quality care in a cost effective manner. To assure continued care in the community, we have developed the following financial policies.
Our billing office staff will gladly assist you with any questions you have regarding your bill. You may contact them at 815-398-9100, Monday – Friday 9:00 AM – 5:00 PM
Payments can be made using cash, check, money order, or credit card. We currently accept Visa, Discover and MasterCard. All patients are required to make any patient responsible portion of a payment at the time of service. If payment is not made, we reserve the right to reschedule your appointment.
Carlson Orthopedic Clinic requests that you familiarize yourself with your health insurance policy and know your co-pay, deductible, co-insurance and policy benefits before your appointment. Your insurance is a contract between you and your carrier. We will assist you in receiving appropriate reimbursement from your carrier; however payment is ultimately your responsibility. You will be required to make payment at the time of service depending upon your insurance plan. All co-pay, co-insurance and deductible amounts are payable at the time of service.
An insurance card must be presented at your first visit to ensure proper billing. You may be asked to present this card for verification purposes at subsequent visits. If you do not have your card and we cannot verify benefits, you may be asked to reschedule your appointment.
While we accept all health insurance plans, we participate as in network providers with the carriers listed below. It is the patient's responsibility to contact their insurance carrier to verify that Carlson Orthopedic Clinic is contracted with them. If a referral is required by your insurance plan, it is your responsibility to contact your primary care physician before your appointment.
We will bill all services to the appropriate primary and secondary insurance carrier. If they fail to respond to our claim, you will receive a statement for charges. Statements are sent monthly and payment is due within 30 days.
Participating Insurance Networks/Plans:
Blue Cross Blue Shield PPO
Patients with insurance from a non-contracted carrier (out of network) will be responsible for any co-insurance, over usual and customary or unpaid balances. If your insurance company indicates a charge is above usual and customary, please understand that this means it is above their allowable rate. We believe the fees for our services are fair and reasonable. They are based upon national and local studies of fees for similar services and are updated annually. Questions related to usual and customary should be directed to your insurance carrier.
Uninsured Patients (Self Pay)
If you are not covered by a health insurance policy you will be considered self-pay. It is to your benefit to collect any recent medical records, x-rays, and/or MRI’s to help keep the cost of your visit at a minimum. We accept discounted fees from insurance carriers and are willing to negotiate a discount for those without insurance coverage. Please call the office to receive a quote before your appointment.
Workers' Compensation/Employment Injuries
All treatment under workers compensation must be pre-authorized in writing by your employer or workers compensation carrier. No appointment will be made if there is no prior approval, if the claim is disputed or denied, or if the patient is considering filing a workers' compensation claim. Once authorization or determination by Illinois Workers Compensation Commission has occurred, the patient is encouraged to contact our office to discuss an appointment.
If a workers compensation carrier denies further authorization for patients already under care by Carlson Orthopedic Clinic, it is the patient's responsibility to contact their health insurance carrier to receive approval for continued treatment.
Accident Case Liability/Auto Accident Injuries
If your injury is a result of a liability, you must provide that information at the time you call the office to set up an appointment, including any attorney information. We will call your liability carrier to verify the claim and a lien will be filed with them. We will bill your liability carrier as a courtesy if we can obtain verification of the incident with the carrier. Once the liability insurance has maxed the patient's health insurance will be billed. Ultimately, the patient is responsible for the billed services 30 days after initial billing. Please note that litigation is NOT considered a valid reason to withhold payment for services. Collection action will begin after no payment is received.