Patient Forms

Authorization for Disclosure
of Health Information

Incapacitated Patient Form

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Premier Dermatology accepts all the following insurance plans:

  • Premier Dermatology Contracted Insurance
    • Advocate
    • Advocate Meridian FHP Medicaid HMO
    • Aetna
    • Beech Street I PPO Next PPO
    • Blue Cross Blue Shield
    • Blue Cross Medicare Advantage PPO
    • Blue Cross Community MMAI HMO (Medicare-Medicaid)
    • Cigna
    • First Health EPO & PPO
    • Cofinity PPO
    • Coventry HMO & PPO
    • Equian
    • Fox Valley Medicine
    • HealthNet PC3
    • Healthlink / Unicare PPO
    • HFN
    • Humana
    • Liberty Healthshare
    • Medicaid – Illinois
    • Medicare
    • MultiPlan HealthEOS PHCS
    • Presence Health
    • Railroad Medicare
    • SEIU - Local 4 HMO & PPO
    • Three Rivers Provider Network
    • Tricare – HealthNet
    • United Healthcare
    • Union Medical (Local 1546) HMO

Premier Dermatology recommends you contact your healthcare insurance provider prior to your appointment to confirm network status, benefits, and any required pre-authorizations prior to receiving care from a Premier Dermatology provider.