Womens Wellness Place Policy Agreement

ADVERTISEMENT

739 Irving Avenue – Suite 530
Syracuse, NY 13210
(315) 478-1158 Office (315) 478-3014 Fax
E-Mail Address:
Web site:
FINANCIAL POLICIES AND PROCEDURES
Welcome to our Practice! We are committed to providing you with the best possible care. If you have medical insurance,
we are anxious to help you receive your maximum allowable benefits. In order to achieve these goals, we need your
assistance and understanding of our payment policy. Please be sure to tell us about any secondary or supplemental
insurance you or your family may have.
This office participates with the following insurance plans:
Aetna US Healthcare
Medicare
Blue Cross Blue Shield of Central New York*
MVP
Empire
PHCS/Statewide
CIGNA Managed Care
POMCO
Fidelis (Medicare Advantage program)
RMSCO
GHI/Emblem Health
Touchstone (Medicare)
Great West
United Healthcare*
Magnacare
Upstate Administrative Services (PPO)
Fidelis (Not through the Healthcare Exchange)
*We do not par with Blue Cross Healthy NY A or B, UHC Americhoice. We are not taking new patients with Medicaid.
The above list is subject to change, so please ask our receptionist for clarification.
At the time of service, you will be responsible for all deductible, co-insurance and co-payment amounts. As a
convenience to you, the WWP will ask you for a credit card account that we may charge any amounts that are your
responsibility. This information will be kept in a secure location.
Referral forms may be required for physicians to provide service as consultants or specialists in some HMO plans.
According to New York State, the HMO Direct Access Law, passed in January 1995, provides female patients who are
members in HMO’s licensed under Article 44 of the New York State Public Health Law, to seek out service from their
gynecologist for 2 routine exams annually. Any services required as a result of those exams, and any acute gynecologic
conditions should also be covered. Please check with your HMO plan to verify that they fall under this category. If there
are any questions or concerns, do not hesitate to contact us. Please remember, if your HMO plan requires a written
referral, it is your responsibility to obtain this referral. It is our pleasure to process claims for all insurance with which we
participate.
For those insurance plans in which we do not participate, payment for service is due at the time the service is rendered,
unless payment arrangements have been approved in advance by our staff. We accept cash, checks, credit & debit cards
(Master Card/Visa/Discover/AMEX). It the responsibility of the patient to submit any non-participating claims to their
carrier, and we will provide you with any necessary information for proper processing.
We will gladly answer any questions relating to your insurance. You must realize however that:
Your insurance is a contract between you, your employer, and the insurance company. We are often not a party to
that contract.
Not all services are a covered benefit in all contracts. Some insurance companies arbitrarily select certain services
they will not cover.
C:UsersLaurieDesktopNewPt Financial.DOC
Revised 3/21/2014

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go
Page of 2