1. Who needs to be seen
2. Name of the insurance carrier
3. Reasons for visit (e.g. illness/problem/physical, etc)
Appointments for urgent problems are available daily. If you need to cancel or change your appointment, please do so within 24 hours prior to your appointment, otherwise there will be a cancelation fee of $75.
Your Appointment: Please arrive 15 minutes before your scheduled appointment time so that we can update your patient information.
Bring Your Insurance Card: You are required to present your insurance card to the receptionist at the time of check-in for an appointment. Please notify the receptionist of any changes in your insurance coverage or other vital information such as your address and phone number.
Copayments: You are expected to pay your office co-pay at the time of check-in.
Late arrival: If a patient is more than 15 minutes late for an appointment, the appointment will need to be rescheduled and will be subject to fee. This is to ensure that the patients who arrive on time do not wait longer than necessary to see the provider. You may be given the option to wait for another appointment time on the same day if one is available. If you think you are running late, please call us.
We make every effort to stay on time with appointments, but emergencies do occur. If we are running behind, we will keep you informed as to how long your wait will be.
- $75 cancellation/no-show fee for non-routine appointments if cancelled within 24 hours
- $150 cancellation/no-show fee for Well Visits/Annuals, if cancelled the same day or within 24 hours.
- $150 cancellation/no-show fee for weight management visits cancelled within 48 hours of appointments
Phone Advice: Patients are encouraged to call with any medical questions they may have. The doctor and nurse are available during most times to answer your questions or return your calls.
Telephone Calls After Hours: After hours, prolonged telephone calls (greater than 5 minutes) or those that lead to a pharmacy or hospital call will be billed as telemedicine visits as per ACA guidelines. This may result in an additional charge in the form of a copay or may be applied towards your deductible. Please contact your insurance company for more information.
Forms: Due to an increased demand for health forms, our new form policy is as follows:
- All forms require 7 business days to process
- $15 for NYC universal health forms
- $30 for non-universal health forms
- $50 for any form needed sooner than 7 business days
Please note: When receiving the form via email, the password will be his/her date of birth (example 01/01/2014)
HIPAA/Prescription Consent Form/Assignment of Benefits Form can be viewed on the Forms page. When you arrive at our office you will be asked to electronically sign an acknowledgment of receipt of these policies.
Insurance and Billing: All patients will be responsible for any fees or co-pays incurred at the time of service. You may be responsible for charges not covered or authorized by your insurance. Our office participates with many insurance plans. If you have questions as to whether we participate with a specific insurance, please ask our practice manager. Should you have any questions regarding filing claim forms, please contact our billing office at (212) 473-4200.
Referral Requests: Many insurance plans require you to have a referral and authorization from your primary care provider to see a specialist outside of your office. We recommend that you become familiar with your health plan’s specific policy. We require 24 hours notice to process these requests and check eligibility with your insurance carrier.
Prescription Policy: If you have an illness that requires prescription medication, you may be asked to schedule an appointment to be examined before treatment is started.
Narcotic prescriptions will not be refilled over the phone. A paper prescription must be obtained for all narcotics.
Medical Records: In order for your medical records to be at our office before your first appointment, you will need to sign a medical release form. We will then request a transfer of your records from your doctor. In the event that you need your medical records sent to another physician, we ask that you give us at least one week notice. You will be asked to fill out a release of information form. If you request a personal copy of your medical records, a fee will be applicable.
Concerns: Our office strives to provide quality medical care in a courteous and professional manner. Should you have concerns regarding your care, please contact the Office Administrator, Karen Oyuela.
No show fee for a weight management visit is $150
Thank you for allowing us to provide your care.