1. Your Coverage – This varies from individual to individual and is generally broken down into In- Network and Out-of-Network Benefits. For example, if you have coverage for Abortion care, you must then determine whether your provider is in-network or out-of-network and then check your coverage accordingly. If you do NOT have coverage for Abortion Care, these services will not be covered whether you go to a provider in-network or not.

2. Type of Provider Network (i.e. is it an HMO or PPO provider network). This will determine whether you are getting care In-network vs. Out-of-network care and thus determine what your coverage is, whether in-network or out-of-network.

• HMO Network – This is a very limited network that requires pre-approval (and/or a Referral) from your insurance company, to be referred to a provider that is out-of-network for various services, i.e. specialist care.
• PPO or POS network – This is generally a larger network and with this insurance plan, you usually do not need a referral or prior authorization to see a doctor.

3. Know all applicable deductible amounts, co-pays, or co-insurance. These are costs that you are responsible for. The easiest way to find this information out, is to call the Member Services Ph. Number on the back of your Insurance card.

• Am I responsible to pay a Copay for the visit?
• Does my deductible apply to my services? For example, if you have a deductible of $5000 and you have already paid $2000 of your deductible, you have $3000 remaining of your deductible before your insurance will cover your services in full.
• Does a co-insurance apply for my services? This is usually a percentage, i.e. 20% co- insurance. You will be responsible for this regardless of whether you have met your deductible.
• Do I need prior authorization for my services? This is also known as a Pre-Approval or Referral. This is permission from your insurance company to go out-of-network for services that are generally not available in-network.
• Do I have a limit on the number of visits allowed? You may have to specify how many visits you would like for your insurance company to approve for coverage.
• Can you verify the following CPT codes to see if they are covered under my plan? The below are the most common CPT codes for services at our clinic.

• For Medication:
  • CPT codes: S0199, S0190, S0191
  • Imaging codes: 76817, 76805
  • Diagnosis Code: Z33.2
  • Visits required: 2
• For Surgical Procedure:
  • CPT Codes: 59840, 59841
  • Imaging codes: 76817, 76805
  • Anesthesia: 01966
  • Diagnosis Code: Z33.2
  • Visits required: 2
• For IUD Insertion:
  • CPT Codes: 58300
  • Device codes: J7298, J7300, J7297
  • Diagnosis Codes: Z30.430, Z30.017, Z30.46
  • Visits required: 2
• For Nexplanon insertion:
  
  • CPT Codes: 11981
  • Device Code: J7307
  • Diagnosis Codes: Z30.430, Z30.017, Z30.46
  • Visits required: 1

We accept ALL Illinois Medicaid Plans. Illinois Medicaid provides 100% coverage for all abortion services, with no out of pocket expense for patients. If you do not have IL Medicaid and are an IL state resident, we can help you apply on-site at your appointment for same-day coverage for all your services.