If you have been asked by our staff or your physician to fill out forms before your appointment,
Please check with your insurance company to see if you are covered for services (whether well care or illness coverage) at Chicago Lake Shore Medical Associates (CLSMA). When you come for your appointment, be prepared to pay any deductible and/or co-insurance identified by your insurance plan. We can generally be found by group name or individual physician.
It is vitally important that you bring everything necessary to your appointment. The first three items are "musts" for everyone. The remaining items may or many not be necessary, depending on your individual situation:
- Insurance card, including the insurer’s name and address and your policy number
- Cash, check, or major credit card (Visa or MasterCard) to pay for services not covered by insurance.
- Your employer’s name, address and phone number – if you are covered by traditional insurance or managed care (HMO or PPO) provided by that employer
- Your spouse’s employer’s name, address and phone number if you are covered by traditional insurance or managed care (HMO or PPO) provided by your spouse’s employer
- Managed Care Referral Authorization – if you are covered by an HMO or POS plan and it is required
- Medicare or Medicaid card, plus the date of your spouse’s retirement (if applicable)
- Name, address and phone number of your referring physician (if applicable)
- Medical records, X-rays, lab test results, and/or pathology slides (if not sent all ready)
- All current medications or a list of current medications, how much of each you take and how often you take it
For information explaining our HIPAA Privacy Complaint Policy, click here.