“Assignment of Benefits” is an arrangement between you and your Insurance Company, asking them to send your reimbursement check directly to your doctor.   When our office accepts an assignment of benefits, that means that we have to wait up to one month for your insurance payment to arrive.   We extend assignment to our clients as a courtesy.   Assignment may be withdrawn if your Insurance Company falls into what we define as the “Nuisance” category.

There are several parts to a Health Insurance Policy

“Deductible” refers to the first portion of care costs incurred during the year.   For example, if you have a $200 deductible, that means that your Insurance Company expects you to pay for the first $200 of the care you receive in the given contract year.   After that, they will pay their portion, or Co-insurance, for care you receive during that year, or until you have received all the benefits your policy provides.

“Co-insurance” refers to that percentage of cost which the Insurance Company expects you to pay.   If your “co-insurance” is 80%, this means that the Insurance Company will pay 80% of what they consider “usual and customary” (or U&C), and that they expect you to pay all the rest of the costs for any and all services provided.

“Co-pay” refers to a specific charge you may have to pay for any specified service.   The most common co-pay is a flat fee for exams and re-exams.   This is much less commonly encountered than standard co-insurance charges.

“Nuisance Insurance” Company characteristics

All reputable Insurance Companies utilize something called “Relative Value Units” (or RVU) to determine the U&C 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 card for services, with fees that are far below what is commonly charged by a profession for a particular service.   This type of Insurance Company falls into the “Nuisance Category”.   If your Insurance Company ignores the nationally-accepted RVU system, to reduce their own costs, 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 claims within 30 days.   Yet, some companies choose to take months to pay valid claims.   If your insurance company participates in 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. 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 mail you a check that day to bring your balance back to zero.

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