We would like to share the following policies with you so that you can understand your responsibility regarding the charges for the services rendered to you by this office:
We are Medicare participating providers. We will bill Medicare. You will be responsible at the time of service for payment of the annual deductible, copayments, and charges for services that are not covered or cosmetic. You may be asked to sign an Advanced Notice of Liability form in the event
that a service, cosmetic or otherwise, is provided which we know is not a covered service by Medicare. If you have a secondary insurance which is part of the Medicare Medigap, Medicare is responsible for submission of your claim. If payment from your Medigap is not received within 30 days of Medicare payment, you will be billed and will be responsible for payment of that balance. Since we do not participate with all secondary insurance carriers, it may be necessary for you to submit your Medicare Explanation of Benefits to your secondary insurance.
We currently participate in a full spectrum of insurances including: Emblem Health, GHI, MVP Healthcare, CDPHP, National Health Administrators, Blue Cross Blue shield, NYSHIP, and United Health Care. View a complete list HERE. We will bill the carrier for all charges that are covered, medically necessary services. You will be responsible at the time of service for any deductibles, copayments, or charges that are non-covered or cosmetic services. If you have a secondary insurance which we participate with, we will file your secondary insurance claim for you. Please note that copayments and deductibles are determined by your insurance carrier. We may not know at the time of service exactly what your responsibility will be and will balance bill upon receipt of your explanation of benefits. Any question regarding that balance or the policy by which it is determined should be directed to your carrier since we may not be able to provide that information to you accurately.
If you have an insurance which requires prior authorization for your visit, it is your responsibility to obtain that referral prior to your visit. Any amount denied by your insurance for lack of appropriate authorization will be billed to you directly and will be your responsibility to pay.
For non-Medicare patients and patients with an insurance carrier with which we do not have a contractual relationship, payment is expected at the time of visit. Please understand that since we do not have a contract with your plan, we are not obligated to adjust our charges based on your plan’s
coverage or benefits.
Cosmetic services will not be billed to any insurance carrier for any reason. Payment is expected in advance or at the time of service at the discretion of our office.
I FULLY UNDERSTAND THAT AT THE TIME OF MY VISIT IF MY INSURANCE IS NOT ACTIVE OR IS AN INSURANCE THAT YOUR OFFICE DOES NOT PARTICIPATE WITH, I AM 100% RESPONSIBLE FOR PAYMENT IN FULL AT THE TIME OF THE VISIT.
IF MY INSURANCE HAS CHANGED SINCE MY LAST VISIT IT IS MY RESPONSIBILITY TO HAVE VERIFIED WITH MY INSURANCE COMPANY THAT YOUR OFFICE IS PARTICIPATING PROVIDER.