Patient Forms and Insurance

Insurance

We are in-network providers for: 

  • Commercial Plans
    Access To Care
    Aetna
    All Saver
    Anthem Blue Cross
    Blue Cross Blue Shield (PPO)
    Century Health
    Cigna
    Coventry Health
    Core Source
    Dart Member
    Evicore
    First Choice
    Golden Rule
    Harken Health
    Health Partners
    Humana (PPO and POS)
    Medsolutions
    Meritain
    Nippon Life Insurance
    Oxford Health Insurance
    Prestige International
    Tricare
    UMR
    United Health Care
  • Commercial HMO Networks
    Advanced Medicine Integration of IL (Site 381)
    Alexian/Medical Care Group (Site 240)
    Amita Healthcare Network (Site 488)
    Health Plus Physicians (HPPO) BCBS/Humana (Site 247)
    Gottlieb West Towns PHO (Site 133)
    Illinois Physicians Alliance (Site 484)
    Lawndale Christian Health Center (Site 454)
    Loyola University Medical Group (Site 349)
    Southwest Physicians Group (Site 235)
    • Site 145 (BCBS)
    • Site 483
    • Site 746
  • Medicare
    Medicare
    Railroad Medicare (Palmetto)
    Supplements
    AARP Medicare Supplement
    Banker Life
    BCBS Supplement
    Colonial Penn Life Insurance
    Country Life Insurance
    Equitable Insurance
    Mutual Of Omaha
    Advantage Replacement Plans
    Aetna Medicare PPO
    BCBS Advantage Community MMAI
    BCBS Advantage Medicare Advantage
    Cigna HealthSpring
    Humana Gold Plus
    Humana Preferred (Medicare/Medicaid)
    Meridian Care
    United Healthcare (Medicare Complete HMO)
    United Healthcare (AARP Complete PPO)
    United Healthcare Group Medicare Advantage (PPO)
    Wellcare (Harmony)
    Medicare Advantage HMOs
    BCBS Advantage HMO- Jencare
    BCBS Advantage HMO- Lawndale Christian (Site 752)
    BCBS Advantage HMO- Northwest Community
    Humana Gold Plus-Jencare
    Humana Gold Plus-Senior Care Partners
    United Health Care
    BCBS Advantage HMO- Advocate
  • Medicaid Networks (All plans)
    Ambetter
    BCBS Family Health Plan (FHP)
    BCBS MMAI
    BCBS ICP
    Community Care Alliance IL (CCAI)
    County Care
    Harmony
    Illinicare
    Medicaid
    Meridian
    Molina Health
    National Imaging Associates/Magellan
    Next Level Health
  • Multiplans
    Group Administrator Ltd
    MHBP
    Standard Life Insurance
    WPS
  • Third Party/Workers Comp
    Absolute Solutions
    Affordable Scan
    America's Choice Provider Network (ACPN)
    Care IQ
    Coast 2 Coast
    Homelink
    Labor Solutions
    Medical Service Quotes
    One Call Care
    Orchid Medical
    Relevant
    Spreemo
    Streamline Imaging
    US Imaging
  • Union Plans
    Department Of Labor
    Health And Welfare 1546
    Health And Welfare 1551
    Health Link
    Health Smart
    Midwest Operating Engineers
    National Association For Letter Carriers
    Roofers Union Trust Fund
    Sheet Metal Workers Health And Welfare 265
    SEIU Healthcare
    Suburban Teamsters Of Northern Illinois
    Union Health Services
  • Veterans Affairs
    Captain James Lovell Federal Health Care
    Department Of Veterans Affairs
    Tricare

We also offer low cost self pay pricing. 

Forms

Below you find Forms that you can print and fill out before you come in for an appointment. Please contact us if you have any problems filling out the forms.