Understanding Insurance

• When you purchase health insurance, you are entering into a contract with the health insurance company; you buy the plan and the company agrees to pay for a portion of your medical costs.
• There are a few ways your health insurance plan will share medical costs with you:
  • You have a fracture and insurance determined your visit, walking boot and X-rays will cost you $400, you would pay the $400 out of pocket and have $600 left in your deductible for the remainder of the year.  
  • That same fracture above now needs surgery, the surgery was billed at $30K by the hospital but the insurance allowed $10k (so you can ignore the 30k!).  You already paid $400 in office, you pay the remainder of your deductible of $600, that leaves $10k-$600= $9400.  You met your deductible! Now your insurance will cover the 80% coinsurance of the remaining $9400 (you pay the remaining 20% of $9400= $1880).  Let's break it down to $400 paid office deductible + $600 paid surgery deductible + $1880 owed coinsurance= $2880!  However, your out-of-pocket max states you will pay a maximum of $2000 in a year.  You would only pay an additional $1000; the insurance has to eat the remaining $880 ($1880-$1000 out of pocket remaining).
• Deductible- The amount you must initially pay, through “covered services”, before your insurance actually kicks in, the lower the better
• Co-Pay- Amount you must pay to be seen at each visit
• Co-Insurance- The amount you must pay, after your deductible is met, before your out-of-pocket max is met
• Out of pocket Max- your paid Deductible + Co-Insurance that is paid before insurance can no longer bill you (your treatment is now fully covered by your insurance).  
• EXAMPLE - $1000 deductible, 80% coinsurance, $2000 out of pocket max
• Ultimately your individual health plan sets the rules:
• What is covered/ allowed
• Which providers are "in-network" vs. "out-of-network"
• Any special rules that restrict access to coverage
• Most importantly, your insurance company decides what your share of the bill will be for each service or item—this amount stays the same no matter which provider you see. For example, the cost to you for a visit with Dr. Williams will be the same as with any other podiatrist in Chicago, no matter what each office charged.
• There are lots of health plans to choose from and they offer a wide variety of coverage options. Generally, less expensive plans have more restrictions, higher deductibles, and less overall coverage. You may pay less up front in monthly premiums, but may be required to pay a larger portion of your medical costs to the doctor/ facility. Keep this in mind as you determine the plan will best meet your healthcare and financial needs.
• Keep in mind that insurance coverage often changes from year to year, and unfortunately, it usually covers less over time. A service that cost you nothing 5years ago might now come with a higher out-of-pocket cost—or may not be covered at all—even if you're on the same policy. It’s always best to check with your insurance provider ahead of time and not make assumptions about what will be covered.

Checking Your Benefits

Before you receive services from any healthcare provider, see if that provider is in-network and how your plan will cover costs for the type of service you will be receiving. You can do this in a few different ways:

• Call your health insurance plan. You can typically find their number on the back of your insurance card.
• Use your health plan’s website- sometimes it can give estimates for common treatments or at minimum the cost of the office visit, Xray’s and Ultrasound testin
• When calling to check on your plan’s in-network status, here is some important information to help you identify us:

Lincoln Park Podiatry
Tax ID: 83-3377604
NPI: 1013143494/ 1093377061
Addresses: 1617 N. Clybourn Ave - Chicago, IL 60614 

OR

2752 n. Southport Ave- Chicago, IL 60614

Here are a few vital questions you can ask to help determine your coverage:

• Is Dr. Williams in-network (Nurse Practitioner visits are billed under Dr Williams)? 
• If not, how can I find an in-network provider?
• If I choose to see this provider anyway (out-of-network), what will my cost be?
• What is my deductible? **If available to us, you will be alerted about your deductible via our online check in service
• How much of my deductible have I met? 
• When does my deductible reset each year? 
• Does my plan provide coverage for Podiatry services?
• Are there limitations or exclusions to my coverage for this service?
• Does my plan require a Prior Authorization or Referral? 
• Does my plan limit the number of visits that I am entitled to? 
• If I am given supplies (such as orthotics or a walking boot) as part of my care, will they apply towards my deductible?
• Will I need to pay a co-payment or co-insurance? If so, how much?

What Happens after your visit?

• Apart from a copay or any services that are not covered by insurance, we will not collect anything in office at your first visit.
• After you are seen, a claim will be submitted to your insurance listing the diagnoses and CPT/ treatment codes based on what you had done.
• About 1–2 weeks after your visit, your insurance company processes the claim and decides two things: 1) which treatments they approve, and 2) what your specific plan requires you to pay. This information isn’t available until the claim has been reviewed. Even if we get prior authorization, insurance companies do not guarantee coverage—they make the final decision after the fact.
• Once your insurance processes the claim, they send the patient responsibility directly to Lincoln Park Podiatry—that’s where your bill comes from. You’ll receive the same details in your Explanation of Benefits (EOB) from your insurance.
• We recommend waiting until you receive a bill from us before making any payment. This helps ensure your payment is properly applied to your account and avoids confusion from using insurance portals.

If your bill is higher than expected, please don’t hesitate to reach out to our office. Remember, the policy you chose determines your costs! We’re happy to explain the charges, work with your insurance, or help set up a payment plan that fits your needs. Sometimes claims need to be reprocessed, appealed, or requires more information. We know dealing with insurance can be frustrating—we’re here to help however we can. If you have concerns, talking with us directly is the best way to find a solution.