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Fees And Insurance

Financial Policy:

Thank you for considering us as your health care provider. We are dedicated to providing the best possible care for you, and we want you to completely understand our financial policies.
We request a valid credit card number to reserve the appointment for most office visits and services.

Patient Costs and Fees:

Unlike typical doctor visits which can be very short, initial visits at our office are very long as the doctor/practitioner's goal is to fully understand your issues and then prepare a protocol and treatment plan to help resolve the underlying cause of your problems.

Initial visits for the following physicians average about one hour and the cost of the initial office visits are as follows;



Internist and Family Practice Physicians   $400-450
Gynecologist, Cardiologist, Dermatologist and other Specialist $500

Follow-up visits average $250 to $400 depending upon a combination of the complexity of your case and the time taken. Testing and treatment costs are additional.

Before starting any treatment or testing we encourage you to speak to one of our patient coordinators for a complete breakdown of costs associated with your health needs. Practitioner fees and schedules vary. Please call 212-794-8800 for details and scheduling.

Payment Policy: Payment is due at the time of service unless arrangements have been made in advance. We accept credit cards, cash or checks payable to "Patients Medical PC".

If you have health insurance, in many cases the testing lab will accept your insurance for blood, stool and urine testing, in which case you will not have to pay for these costs at the time of your visit.

Cancellation Policy:

As a courtesy, if you need to cancel an appointment, please let us know as soon as possible. If you cancel with less than 24 hours' notice, or if you miss your appointment time, our billing system will automatically bill you for the full fee for the missed/canceled appointment. Cancellations for Monday appointments must be made by 12 noon on Friday to avoid being charged. You can change appointments by calling 1-212-679-9667 or 1-212-794-8800.

 

Insurance & Filing Instructions

Insurance Policy: Patients Medical generally does not participate in insurance plans or networks. There are some physicians in our practice that may be in-network providers for some insurances. Please call 212-794-8800 to find out if the physician you would like to see takes your insurance. Most of our doctors and practitioner are not "in network" providers and the fee for their services is due at the time of the office visit. Many insurance and managed care companies may reimburse you for your office visit fees or provide coverage for the treatments we offer. Others offer case management and special waivers to those with a serious illness or injury.

We encourage you to inquire about whether our services may be covered as part of your plan or as a special benefit in light of your condition. We are happy to speak to your insurance company to describe the content and benefits of your program.

Keep in mind that your insurance policy is a contract between you and your insurance company. If you are insured by a plan that we do not have a prior arrangement with, we will prepare the claim for you on an unassigned basis. This means the insurer will send the payment directly to you. Therefore, our charges for your care are due at the time of service.

If you have determined that your insurance plan will cover some or all of the treatments that you receive at the Center, we will be happy to provide you with the documentation you need to submit a claim for reimbursement.
If you have questions about fees that are not answered in the above information, please call the Center at 1-212-794-8800, or write to us at media@patientsmedical.com.

We encourage you to inquire about whether our services may be covered as part of your plan or as a special benefit in light of your condition. We are happy to speak to your insurance company to describe the content and benefits of your program.

Keep in mind that your insurance policy is a contract between you and your insurance company. If you are insured by a plan that we do not have a prior arrangement with, we will prepare and send the claim for you on an unassigned basis. This means the insurer will send the payment directly to you. Therefore, our charges for your care are due at the time of service.

If you have determined that your insurance plan will cover some or all of the treatments that you receive at the Center, we will be happy to provide you with the documentation you need to submit a claim for reimbursement.

If you have questions about fees that are not answered in the above information, please call the Center at 1-212-794-8800, or write to us at Media@patientsmedical.com

Visit Check-Out: When you check out you will receive a nationally standardized claim form, a HCFA 1500 (medical) that will include all necessary information that is needed to file for reimbursement, along with a receipt for the services rendered. At check-out, you may also request a copy of your labwork for that date of service. Future requests for another copy will be available at a cost of $25.

Filing for Reimbursement: Methods for filing vary by company, but generally you will need to mail the claim form provided at check-out (we suggest keeping a copy for yourself) to the address or post office box provided by the insurer or your employer. All of our practitioners have opted-out of Medicare. For secondary payers to Medicare, we will provide a copy of the practitioner's opt-out affidavit.

Insurance Requests: If we get requests for additional information, we will forward the request to you along with copies of the requested notes, x-rays, etc. for submission to the insurer. If your insurer requires their form be filled out and submitted, you will need to fill it out and in the section where your practitioner's signature or specific information is needed write, "see attachment." Then attach the claim form, notes, x-rays, etc. we provided you and mail them to the insurer. As always, we urge you to make a copy of the information before submitting.

Not Recognized Care: Some of the care provided may not be recognized by your insurance company. Often these claim forms will be returned to you or us with a message like, "in order to process your claim we must have a correct CPT code" or "CPT code not valid". Some of the services we provide do not have CPT codes, as the codes are set by the conventional medical community. Insurers rarely pay for services without a CPT code. We can provide you with a brief description of these services that you can submit for claim review, in the event you still wish to pursue payment.

Reimbursement Problems: Securing payments for insurance companies can be difficult, whether the services rendered were conventional or alternative. Your best bet is to keep close track of what and when you submit to your insurer and challenge or appeal any decision they make which is not explained to your satisfaction. If you are still dissatisfied and believe the insurer has not properly reimbursed you, you have two other options that are occasionally effective:

  1. Contact your employer and ask them to intervene on your behalf. They often have more clout with the insurer, since they hire the insurer and pay the bill.
  2. Contact your state's insurance department. They will typically take your complaint directly back to your insurer, asking them to explain why (based on the contract) that something was not covered.

For all other questions about fees and insurance please call our billing department at 1-212-794-8800 ext. 140.

Next Steps:

While you may find this medical information useful, as the next step we strongly recommend that you make an appointment to see one of our physicians to ensure that your health issues are properly addressed.

To schedule an appointment with our physicians, please call our patient coordinator at 1-212-794-8800, send the form below or an email to: media@patientsmedical.com. We are currently accepting new patients and look forward to being of assistance.

We are located at: Patients Medical PC, 800 Second Avenue, Suite 900 (Between 42nd & 43rd Street), Manhattan, New York, NY 10017.