Prepare for your visit
Patients should bring in:
- Insurance card
- Co-pay (if you have one)
- Photo-ID: Driver’s license, state ID or Military ID
- Forms filled out (if possible)
- X-rays or test results: if applicable
Workers' Compensation
- Claim number
- Insurance name, adjuster name, billing address and phone number
- Employer name, address, contact and phone number
Download Forms
In order to save time once you arrive, please download the forms below and fill them out prior to your visit.
New patients or patients that have not had an appointment within the year:
Previous patients with a new injury or condition seen in the past year:
Requests for Form Completion:
(Disability, Handicap, Work Comp, etc.)
To view these PDF files, you will need to use Adobe Reader or the equivalent.
To help you prepare for your visit to Crystal Lake Orthopedics, we have provided some information about your visit in addition to valuable insurance information.
Insurance Information
Crystal Lake Orthopedics participates with most national and local insurance plans. It is the responsibility of you, the patient, to understand your insurance policy, benefits and limitations. As a courtesy to you, we will file a claim with your insurance company for benefits. Updated insurance information is required at the time of your visit. If you do not provide us with a current/active insurance card, Crystal Lake Orthopedics will ask you to reschedule your appointment. Based on your coverage, you will be responsible for any co-payments, co-insurance, or other amounts due.
Insurance and Patient Responsibility
- Please understand that insurance coverage is an arrangement between you and your insurance company, and that your insurance company may not provide full payment of your medical costs.
- Prior to making an appointment, check with your carrier to verify we participate in your plan.
- If your insurance plan requires you to obtain a referral from your primary care physician, it is your responsibility to obtain this referral prior to your scheduled appointment.
- If your insurance plan requires a co-payment, this payment is expected at the time of service.
- If you are scheduled for diagnostic testing or surgery, please check with your insurance company to determine if it requires you to obtain a pre-authorization or second opinion.
Disability and Insurance Forms
Crystal Lake Orthopedics will complete your disability or other insurance forms. In order to accommodate everyone's needs, we ask that you turn in the forms as soon as possible so that we have sufficient time for completion. Please allow 5-7 business days for your forms to be completed. All forms are completed in the order in which they are received. There is a charge for these forms prior to completion.
Below you will find a listing of some our participating plans:
- Aetna
- Allied Benefits
- Blue Cross Blue Shield PPO
- Cigna
- HMO of Illinois (MCPO) Site 354
- Humana
- Medicare
- PHCS
- United Health Care
- Workers' Compensation