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     What You Can Expect From Us:  We accept many of the insurance plans currently offered in the
     Chicago and Northwest areas. As a courtesy to you Metrodocs will:

     - Submit claims on your behalf directly to your insurance carrier for appropriate payment.
     - Provide you with information regarding balances owed to Metrodocs once all insurance payments
       have been made.
     - Provide you with an account statement each month your account has a balance.

     What We Expect From You:  Metrodocs expects the following from its patients upon provision of
     services:

     - Patients must provide us with their insurance card and a picture ID.
     - Patient will be responsible for any co-payments, deductibles or non-covered services at the time
       of service. This includes amounts denied or not covered by the patient's insurance plan.
     - Medicare patients will be asked to sign a waiver for non-covered services at the time of service
       allowing us to bill you directly for these non-covered services.
     - Self-paying patients are expected to make payment arrangements at the time services are
       provided.
     - Patients balances are to be paid in a timely manner. Balances that have not been paid after three
       monthly statements will be turned over to our collection agency.
     - A fee of $40.00 will be charged to the patients account for any returned checks.
     - All disability forms, medical records, return to work forms, etc. must be prepaid before they are
       mailed out.

                                                PAYMENT AND FINANCING OPTIONS

     Metrodocs offers the following payment and financing arrangements to facilitate the handling of
     patient financial obligations:

     - Metrodocs accepts cash, check, Visa, Master Card, Discover and American Express.
     - The billing department can arrange a budget plan that requires a payment at the time of service,
       with the remaining balance payable in installments over a three to six month period.
     - If you have any questions regarding our payment policies or a billing issue please call our Billing
       Office at (847) 296-3040, extension 240. Our staff will be happy to assist you.

                                                          MANAGED CARE / HMO

     We participate in a number of HMO Insurance Plans. Most HMO plans place specific restrictions
     on their coverage. As we cannot always remember who your insurance carrier is, PLEASE INFORM
     OUR STAFF WHENEVER YOU CALL OR COME TO THE OFFICE IF YOU ARE COVERED BY
     SUCH A PLAN OR IF YOU HAVE CHANGED PLANS. This will enable us to comply with the rules
     of your plan and refer you to the appropriate hospital, emergency facility, laboratory, or specialists
     that are covered by your plan. IF YOU DO NOT INFORM US, YOU WILL BE HELD RESPONSIBLE
     FOR FEES NOT COVERED BY YOUR PLAN. Please familiarize yourself with your HMO plan and
     its rules, benefits and restrictions. If you change from one HMO plan to another, please contact our
     office immediately so that we can update your registration.
 
 
     
     Below are common forms to view and print:
 
     - Demographic Form        - Payment Policy
     - Privacy Practices 
    
     - Need Adobe Acrobat Reader? (.pdf format)
       Click here for a free copy of the program.

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