All reputable Insurance Companies utilize something called “Relative Value Units” (or RVU) to determine the U&C (usual and customary) charge which they will pay.   The RV unit was designed to evaluate the time, complexity, and overhead costs associated with every service provided by your doctor.

The RV unit is a nationally accepted unit of value, which may be modified by a “locality percentage”. This explains why care in the Chicago region would cost more than in a smaller town that has lower overhead costs.

Some Insurance Companies create their own rate cards, paying providers fees that are far below what is commonly charged by a profession for a particular service.   This kind of Insurance Company falls into the “Nuisance Category”.   If your Insurance Company ignores the nationally accepted RVU fee system, simply to reduce their overhead, they do so at your expense, because that forces you to make up the difference.

Another nuisance activity is taking longer than 30 days to pay a claim.   Illinois Insurance law directs Health Insurance companies to pay all claims within 30 days.   Yet, some companies choose to take months to pay valid claims.   If your insurance company practices these unfair and illegal tactics, we will help you file your claim, but we will not accept assignment of your benefits.

We verify your Insurance coverage during your first week of care, but there is no way for us to determine if your company will play “fair” by using the RVU system.   We cannot predict what they may pay for a particular service.   Only you, the policy holder, can affect how they choose to behave, because of the contractural relationship that exists between the two of you.

We may agree to take on the extra expense of filing your claims as a consideration to you, but we have no contractual relationship with your Insurance Company (except for BCBS). Once your insurance company pays their portion for any date of service, you will be billed for any outstanding balance due. If they make any overpayments, we will cut you a check that day, to bring your balance back to zero.

If you have any issues with how your insurance company manages or pays for your care, it is your responsibility to resolve those issues with them.