PANACEA Allergy - NOW HIRING
Paid High School and Gap Year
Pre-Med Interns for 2025-26


INSURANCE PHASE OUT 2025



Good news! We heard you and are making changes this summer 2025! Due to misdirected patient dissatisfaction with commercial/government insurance payment capitations, overly inflated premiums, billing hassles, denials, increased deductible and patient responsibilities, recouped payments (insurers taking payments back 2 years later for their/employer/patient mistakes), skyrocketing costs of staffing and overhead, AND DECREASING PAYMENTS across all payers since 2017 (Medicare RVU now exactly where it was in 1993, meaning payments are less than half of what they should be when adjusted for inflation)............and so on....

We will NO LONGER BE ACCEPTING INSURANCE as a form of payment.


A very simple fee-for-service, at the time of service, is planned with a possible option for concierge service if desired. All services are eligible for HSA.


Think of your future experience here as you would a trip to the grocery, plumber, oil change, nail salon, lawyer, consultant, teacher, massage, shoe repair, electrician, contractor, restaurant, movies, amusement park, Amazon, landscaper, concert, housekeeper, nanny or any other service rendered on the planet. It is time to ditch the insurance scam.


Same day comprehensive new patient workups will return (instead of divided into 3 visits per capitation rules).

1 hour consultations with Dr Sullivan will return.

Payment for services that we render will return.

Your health will return.

All good.



CAPITATION INVASION 2024



MOST PRIVATE, EMPLOYER, INDIVIDUAL, AND EXCHANGE PLANS HAVE CAPITATED DAILY COVERAGE!


IN ADDITION, ALLOWANCES ARE BASED ON THE HEALTH CONDITIONS (DIAGNOSES) THAT THE INSURER (not patient or practitioner) DEEMS RELEVANT AND THE SEVERITY OF PRESENTATION.


MANY WILL CAP PAYMENTS FOR SERVICE EXCEEDING 25 MINUTES PER DAY FOR ESTABLISHED PATIENTS AND 30 MINUTES FOR NEW PATIENTS.


MOST ALLOW FOR ONLY ONE TYPE OF SERVICE PER DAY (OFFICE VISIT vs PRESCRIPTION REFILL/LAB ORDER vs PROCEDURE).


MANY INSURANCE PLANS ARE PHASING OUT OR HAVE ALREADY ELIMINATED TELEHEALTH COVERAGE.



Client Billing and Payment options:



Phase out summer 2025.

Commercial Insurer Payment
(non-government plans)
Plus
"Patient Responsibility" Payment



Personal credit card, HSA card



Time Based CPT Billing of Commercial Insurance Plan.

Commercial Plan Fee-Schedule Discounts.

Patient responsibility is due at time of service.

Security Deposit Required


Pros:

1. Commercial insurer may pay some of your cost depending on your plan rules. We are in-network for most.


Cons: (per INSURER rules):

1. Initial visit is capped at 30 minutes (for our specialty).

2. Procedure visits (skin tests, oral challenges) require separate visit.

3. Follow up visits capped at 25 minutes/day, requiring several to finish the initial workup or splitting typical service into 2 visits.

4. Telehealth no longer a covered service for most.

5. Evaluation and management service requests, by phone or fax, are billed on day of service (prescription refills, laboratory orders, prior authorizations).

6. Risk of insurer denying claim due to coordination of benefits or other misprocessing issue

(non-payment- patient and insurance problem).

7. Risk of insurer taking back payment

(recoupment-patient or insurance problem).

8. Risk of insurer not responding to claim

(non-response- patient, insurance or our problem).






Phase out summer 2025-
Medicare opt-out planned

Government Plan Payments
Plus
"Patient responsibility" Payment



Personal credit card and HSA card



Time Based CPT Billing of Government Plans

Government Plan Fee Schedule Discounts

Patient responsibility due at time of service


Pros:

1. Government insurer may pay some of your cost depending on your plan rules. We are in-network for most.

2. Follow ups, acute care, telehealth and yearly maintenance visits are offered with minimal insurance policy restrictions on time and level of service.

3. Streamlined processing of claims with less risk of errors

4. Straightforward rules for payment/expectations


Cons: (per CMS rules):

1. Procedure visits (skin tests, oral challenges) may require separate visit.

2. Evaluation and management service requests, by phone or fax, are billed on day of service (prescription refills, laboratory orders, prior authorizations).

3. Risk (less than private) of insurer denying claim due to coordination of benefits or other issue.

(non-payment- patient and insurance problem).

4. Risk (less than private) of insurer taking back payment

(recoupment-patient or insurance problem).

5. Risk (less than private) of insurer not responding to claim

(non-response- patient, insurance or our problem).



Self Pay



Personal credit card, Venmo, Zelle or HSA card



Time based CPT billing of Patient/Guarantor.

Self-pay discount.

Payment or payment plan expected at time of service.

Opt-out of insurance billing.


Pros:

1. No security deposit required.

2. Initial comprehensive all-in-one visit that includes history, physical, skin testing, assessment and personalized action plan.

3. Follow ups, acute care, telehealth and yearly maintenance visits are offered without insurance company restrictions on time and level of service.

4. Interval prescription refills and laboratory orders provided without additional fees.

5. Outside laboratory and pharmacies may continue to bill your insurance plan.

6. Insurance-administration-reduction credit available.


Cons:

1. Services will not be counted toward your insurance plan deductible and limits.

2. Insurance will not provide any payment for our service

3. HSA card transactions may need additional documentation provided by the patient from us.




Concierge



Personal credit card and HSA card



Coming soon



737 Saint Johns Ave
Highland Park, IL 60035

P: 847-805-8088
F: 847-805-8844



PANACEA ALLERGY, ASTHMA & IMMUNOLOGY