Patient Forms

• HIPAA Release and Confidentiality Form
• M-Chat Screening for 18-Month Checkup
• New Patient Medical Information Form
• Patient Information Form
• Permission for alternate caregiver to seek medical treatment for patients
• Policy for Release of Info - Explanation of Cost and Procedure
• Request for Release of Medical Information

Billing Information

Children’s Health Partners, SC accepts the following insurance plans; however, patients' parents are responsible for verifying with their insurance company that we are included in their specific plan.

All doctors are contracted with all plans and are listed by physician's name or CHP's tax ID: 36-4350103.

• Aetna Open Choice (PPO), Managed Choice (POS), Elect Choice (EPO), POS II
• BC/BS PPO, Blue Advantage PPO, Blue Choice POS (NO BC/BS HMO or HMO of IL)
• Beech Street/CAAP Care PPO
• Choicecare PPO
• Cigna HMO, PPO, POS- Network POS, Open Access and EPO
• Cofinity PPO
• Evolutions Healthcare Systems PPO
• First Health/Coventry PPO, POS (formerly Affordable)
• Great West HMO, PPO, POS (formerly One Health Plan)
• Galaxy PPO (formerly MCI)
• Healthcare's Finest Network (HFN) PPO, POS, EPO
• Health Star PPO & Select (Now preferred Health Network)
• Humana Choice Care PPO
• MCS Patient Centered Healthcare Network PPO
• Multiplan PPO (formerly Admar, Preferred Health Network, BCE Emergis, Principal PPO)
• National Provider Network PPO
• Preferred Network Access (PPO)
• Preferred Plan, Inc. PPO
• Private Health Care Systems (PHCS)/Multiplan PPO, POS
• PPONEXT PPO
• Tricare PPO, POS, EPO
• UNICARE Life and Health Ins. Co. PPO (No HMO)
• United Healthcare of IL PPO, POS, EPO, Select Plus POS, Open Access PPO (certain), HMO’s (NO SELECT HMO)
• USA Managed Care Organization PPO

* There are also private healthcare insurance plans that allow patients to see any doctor. If there are any questions, contact our biller at (630) 646-3786 or have patient verify that they will reimburse us for service. (Example: BSSI).