Insurance, Billing & Reimbursement

Prism Health Care Services accepts most types of health insurance plans, HMOs and managed care plans. Below is a list of the common plans accepted. If you do not see your plan listed, we invite you to stop in or call 847-310-4730 to speak directly with our friendly and knowledgeable customer service representatives.

  • Aetna-Medicare Replacement
  • Aetna Better Health/IL Medicaid
  • BCBS of Illinois
  • BCBS Blue Choice
  • BCBS Blue Choice Preferred
  • BCBS Community ICP
  • BCBS Community MMAI
  • BCBS Medicare Replacement
  • CIGNA Healthsprings
  • CIGNA ICP
  • CIGNA MMAI
  • CIGNA PPO*
  • CountyCare
  • HFN
  • Humana
  • Humana Gold
  • Illinois Medicaid
  • Medicare
  • U.M.R.
  • United Healthcare
  • United HealthCare Medicare Solutions

*Network participation and co-payment vary by plan.

The Billing Process

  • Prior to most purchases and/or rentals, our customer service representative will call your insurance plan to determine what documents are required to submit a claim for the prescribed durable medical equipment services.
  • During the insurance verification process, our customer service staff will obtain an estimate of your current deductible and additional out-of-pocket expenses that you may be financially responsible for paying.  In addition, our team will also verify if prior approval is required prior to delivery of services.
  • All deductibles, coinsurance and copayments will be collected at the time that services are provided. It is important to review your personal policy as insurance plans vary with durable medical equipment coverage, deductibles and coinsurance amounts.

 

Common Questions

What is a deductible?
A deductible is a fixed yearly dollar amount that you pay out of pocket before your insurance begins to pay. Not all insurance plans have deductibles.

What is coinsurance?
Coinsurance is the percentage of medical costs the policyholder pays after a deductible has been met. For example, Ron has oxygen equipment and sees his doctor regularly. Ron’s annual deductible is $1,000. After Ron’s deductible has been met, his insurance plan pays 90% of the charges, making Ron responsible for remaining 10%. This 10% is Ron’s coinsurance. 

What is secondary insurance?
Secondary insurance is a separate policy that can help pay for your coinsurance payment. For instance, if Ron had a secondary insurance policy, it would pay for most or all of the 10% payment Ron is responsible for after his primary policy paid the 90%.

What is prior authorization?
Some insurance plans require a prior authorization before delivery of durable medical and respiratory equipment. The Prism Health Care Service customer services team is trained to work with your insurance plan to obtain the required documents to process the prior authorization request. For rental equipment, it is important that you follow up with your treating physician to ensure there is not a delay in the authorization process. Most insurance companies provide a prior authorization ranging from 1-3 months. Prism Health Care Services will work with your insurance plan to obtain an extension on your prior authorization. If you have not seen your treating physician since the start of the rental equipment period, it is likely your insurance carrier will not approve extending the prior authorization period. Insurance plan prior authorization can take up to 5 business days.