Billing and Payments

To make credit card payment over the phone for statement balances please call 847-490-8900 between 9am and 5pm.

Understanding common insurance and billing terms:

  1. Copay (or Copayment)
    • Definition: A fixed amount you pay for a specific medical service or prescription at the time of service.
    • Example: You might pay a $25 copay for a doctor's visit, regardless of the actual cost of the visit.
    • Key Point: Copays are often used for routine services like doctor visits or medications, and they are usually a small, fixed amount.
  2. Coinsurance
    • Definition: The percentage of the cost you pay for a medical service after you’ve met your deductible.
    • Example: If your coinsurance is 20%, and the total bill for a hospital stay is $1,000, you pay 20% ($200), and your insurance covers the rest.
    • Key Point: Coinsurance is a cost-sharing structure, and it typically applies after you've met your deductible.
  3. Deductible
    • Definition: The amount you must pay out-of-pocket for medical services before your insurance starts to pay.
    • Example: If your deductible is $1,500, you need to pay that amount before your insurance covers most services (except copays).
    • Key Point: You must meet your deductible first (with some exceptions like preventive care) before your insurance kicks in for most services.

Summary of Differences:

  • Copay: A fixed fee for specific services (e.g., doctor visits).
  • Coinsurance: A percentage of the cost of services after your deductible is met.
  • Deductible: The amount you pay before insurance coverage begins.

An adjustment on insurance payments refers to the portion of a medical bill that your healthcare provider has agreed not to charge you due to a contract with your insurance company. Essentially, it's a discount that the provider applies, which reduces the amount you owe.

How Adjustments Work:

  • Insurance Networks: When healthcare providers are in-network with your insurance company, they agree to accept a negotiated or discounted rate for their services. This rate is usually lower than the provider's regular charges.
  • Billed Amount vs. Allowed Amount: The healthcare provider may bill the full price for a service, but the insurance company will only allow a certain amount based on their agreement with the provider. The difference between the billed amount and the allowed amount is the adjustment.
  • No Out-of-Pocket Cost: You are not responsible for paying the adjusted amount. Instead, you only need to pay what your insurance indicates, such as your copay, coinsurance, or deductible (if applicable).

Example:

  • A doctor’s visit costs $200, but the insurance company's allowed rate for the service is $120.
    • The adjustment would be $80 (the difference between $200 and $120).
    • You would only be responsible for paying based on the $120 allowed amount, minus what your insurance covers.

In summary, an adjustment reduces the total bill by the negotiated discount between the provider and the insurance company, lowering what you might have to pay out of pocket.



The key difference between a wellness (annual) doctor visit and a problem-focused doctor visit lies in the purpose and focus of the visit:

  1. Wellness Annual Doctor Visit
    • Purpose: A wellness visit is preventive and designed to maintain your overall health. The focus is on evaluating your general well-being, identifying any potential health risks, and preventing future health issues.
    • What's Covered:
      • Physical examination (height, weight, blood pressure, etc.).
      • Preventive screenings (cholesterol, blood sugar, etc.).
      • Vaccinations (as needed).
      • Counseling on diet, exercise, and lifestyle habits.
      • Discussion of family history and age-related risks.
    • Insurance Coverage: Often fully covered by insurance with no out-of-pocket cost to you (no copay, deductible, or coinsurance) under the Affordable Care Act for in-network providers.
    • Key Point: The visit is preventive and not related to any specific current health problem or symptoms.
  2. Problem-Focused Doctor Visit
    • Purpose: A problem-focused visit addresses a specific health issue or symptom you're experiencing, such as pain, illness, or a chronic condition that needs management.
    • What's Covered:
      • Discussion of specific symptoms (e.g., headache, stomach pain).
      • Diagnosis and treatment plan for the current health issue.
      • Prescription medications or tests (if needed).
      • Follow-up care for ongoing conditions (like diabetes or high blood pressure).
    • Insurance Coverage: This visit typically involves out-of-pocket costs, such as a copay or coinsurance, and counts toward your deductible.
    • Key Point: The focus is on diagnosing and treating a specific problem or concern rather than preventive care.

Summary of Differences:

  • Wellness Annual Visit: Preventive, focused on overall health, typically no cost, and doesn’t address any current health problems.
  • Problem-Focused Visit: Aims to diagnose or treat a specific issue, and often involves out-of-pocket costs based on your insurance plan.