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Preparing for your appointment
- Please complete the intake forms below and email them (along with a photograph of the front and back of your insurance card, if using BCBS), to me the at least 3 business days before your appointment.
- Failure to adhere to this policy will result in the cancellation of the appointment, and a cancellation fee will be collected before rescheduling.
- All patients are kindly asked to email me or bring along any results of pertinent tests such as x-rays, MRIs, CT scans, blood work etc, to your first appointment.
Click on each document below relevant to your appointment type, download it, fill it out and email the documents at least 3 business days before your first appointment.
All Physical Therapy patients:
MEDICAL SCREENING QUESTIONNAIRE PAYMENT AND CANCELLATION POLICY
INFORMED CONSENT CREDIT CARD AUTHORIZATION (*
DEMOGRAPHIC INFORMATION NOTICE OF PRIVACY PRACTICES (please submit signature page only)
Patients using BCBS also need to submit insurance information
(* Credit card information is not required for prepaid appointments
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Consultations and Health Coaching clients:
MEDICAL SCREENING QUESTIONNAIRE and PAYMENT AND CANCELLATION POLICY only.
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Personal training clients:
INFORMED CONSENT FOR PERSONAL TRAINING MEDICAL SCREENING QUESTIONNAIRE and
PAYMENT AND CANCELLATION POLICY only.
All Physical Therapy patients:
MEDICAL SCREENING QUESTIONNAIRE PAYMENT AND CANCELLATION POLICY
INFORMED CONSENT CREDIT CARD AUTHORIZATION (*
DEMOGRAPHIC INFORMATION NOTICE OF PRIVACY PRACTICES (please submit signature page only)
Patients using BCBS also need to submit insurance information
(* Credit card information is not required for prepaid appointments
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Consultations and Health Coaching clients:
MEDICAL SCREENING QUESTIONNAIRE and PAYMENT AND CANCELLATION POLICY only.
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Personal training clients:
INFORMED CONSENT FOR PERSONAL TRAINING MEDICAL SCREENING QUESTIONNAIRE and
PAYMENT AND CANCELLATION POLICY only.
INSTRUCTIONS FOR SCHEDULING APPOINTMENTS
Click the "Schedule Appointment" button above to schedule, then create an account using your full name and use that same account every time you schedule an appointment. Do not choose the option to "skip the login process"!
You do not need a referral for physical therapy.
Additional Information
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TELEHEALTH SESSIONS:
Delivered via https://doxy.me/lilianholmwellness on your computer or mobile phone. The convenient link to the appointment remains the same from one appointment to the next. |
PAYMENT
Accepted forms of payment: Cash, Check, Zelle, credit card, most health savings account (HSA) cards. Accepted forms of payment: Cash, Check, Zelle, credit card, most health savings account (HSA) cards. |
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CONTACT INFO:
Phone: (847) 208-8063 (please text only during business hours, use email outside of business hours) Email: [email protected] or click here to contact me via email. Note: Please email or text instead of leaving a voicemail message. AVAILABLE HOURS Additional appointment times may occasionally be available by request. Email to inquire about a specific time. PAYMENT FOR SERVICES - FAQ Physical Therapy is covered by health insurance. I accept insurance on a limited basis, and am an in-network provider for Blue Cross/Blue Shield PPO. Call your insurance provider prior to scheduling an appointment to make sure that it will be covered. BCBS insurance plans vary a lot in terms of whether e.g. pre-authorization for services is required. Clients covered under an out-of-network insurance policy will receive an itemized receipt (superbill) that they may submit to their insurance company for reimbursement. Please understand, however, that Lilian Holm Wellness does not assume any responsibility for how your insurance company handles the charges. Health and Wellness Coaching, Consultations and Personal Training are self-pay appointment types. APPOINTMENT CANCELLATIONS If you need to cancel an appointment, please do so as soon as possible. Please be considerate and do not wait until right before the cancellation window (24 hrs), as cancellations this close to the appointment time are hard to fill. Out of respect for your fellow patients and your therapist, cancel early in order to give other patients an opportunity to book the appointment slot. Cancellation policy: Appointments must be cancelled 24 hours before the scheduled appointment time. Late cancellations and no-shows, no matter what the reason for them, will lead to a $155 cancellation fee to cover the monetary loss incurred. Agreeing to the cancellation policy is a prerequisite for scheduling an appointment. Questions about the cancellation policy? Read more here . CANCELLATIONS OF PRE-PAID APPOINTMENTS The fee charged for pre-paid appointments will be refunded upon request (please note that this is not an automatic process) minus the fee collected for the transactions by Square. If you wish to reschedule a prepaid appointment, please contact me directly using the form at the top of the page. WHY IS THERE A CANCELLATION POLICY? Clinics guard against the financial loss that last-minute cancellations and no-shows present through a variety of measures, such as over-booking or double-booking clients. With individualized one-on-one care it is not possible to double-book patients. This makes a cancellation policy a necessity. Agreeing to this policy is a prerequisite for receiving the services, and all patients sign a binding form detailing the cancellation policy before therapy is initiated. Cancellation policies exist to keep the practitioner in business so that s/he can continue to serve you. As such, it is not affected by extenuating circumstances, and the cancellation policy is always in effect, regardless of what the reason for the cancellation is. Agreeing to the cancellation policy as outlined and signed is a prerequisite for receiving the services of Lilian Holm Wellness. Any exemptions would be unfair to all other patients bound by the very same policy and render the business model as described impossible. |
Scan QR code above to submit payment in order to save on Cc fees.
When using Blue Cross Blue Shield the insurance company sets the price. The patient is responsible for the deductible and the copay/coinsurance, when applicable. Self-pay fees are as follows: The cost of the initial evaluation is $255. Subsequent visits are $165. Physical Therapy Consultations (65 minutes) : $255 Extended Physical Therapy Consultations: $450 (2hrs 10 minutes) Online (Telehealth) Personal Training (50 minutes): $155 Aetna, Cigna, United Healthcare etc policy holders are seen for physical therapy on a self-pay basis, and may submit their superbill (a detailed invoice containing all pertinent codes required for reimbursement) to their insurance company for reimbursement as applicable. Please note that all patients, except pre-paying patients, are required to keep a valid credit card on file at all times! When using Blue Cross Blue Shield the insurance company sets the price. The patient is responsible for the deductible and the copay/coinsurance, when applicable. Self-pay fees are as follows: The cost of the initial evaluation is $255. Subsequent visits are $165. Physical therapy Consultations (65 minutes) : $255 Extended Physical Therapy Consultations: $450 (2hrs 10 minutes) Online (Telehealth) Personal Training (50 minutes): $155 Aetna, Cigna, United Healthcare etc policy holders are seen for physical therapy on a self-pay basis, and may submit their superbill (a detailed invoice containing all pertinent codes required for reimbursement) to their insurance company for reimbursement as applicable. Please note that all patients, except pre-paying patients, are required to keep a valid credit card on file at all times! If your appointment is billed to insurance, you must keep a valid credit card (not debit card) on file at all times. After submission, the insurance company determines what/if you owe. Accepted Insurance plans: Blue Cross and Blue Shield, PPO only. APPOINTMENT TYPES Please download the HIPAA compliant home exercise app AC Health in the Apple app store or Google play store on your phone prior to your evaluation. PHYSICAL THERAPY TELEHEALTH APPOINTMENT Telehealth (video) appointments, for both individuals using insurance or self-pay patients. For patients using insurance choose Telehealth Physical Therapy Session - BCBS- Initial evaluation or follow-up. Self-pay patients: choose Telehealth Physical Therapy self-pay evaluation for the initial appointment, and Telehealth Physical Therapy Session for Self-Pay patients for subsequent appointments. You may choose to pay using a credit card, or save by paying using cash/bank transfer via Zelle. CONSULTATIONS Educational video consultation, intended for individuals with hypermobility disorders (EDS/HSD) wishing to better understand the concerns and options related to these conditions. Consultations can also be used to connect me to your local physical therapist to guide them through general information about hypermobility conditions to help them adapt treatment to be more appropriate for these disorders. Consultation appointments cannot be used to diagnose or treat individual conditions. Choose either: Physical Therapist Consultation - US and International (70 min) or Extended Physical Therapist Consultation - US and International (2 hrs 20 minutes) HEALTH COACHING Health coaching sessions are educational appointments, where the client chooses the topic(s) among any aspect of health-related topics. Health coaching appointments are self-pay appointments. REFERRALS The State of Illinois has direct access to physical therapy, which means that you do not need a referral from a physician or other provider in order to have physical therapy. Some BCBS plans do, however, require a referral. Please call your insurance company prior to scheduling to find our if your policy does, as a missing referral is cause for rejection of charges by the insurer. You do not need a prescription for Consultations and Health and Wellness Coaching or Personal Training. |
