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Patient Financial Responsibility Policy


 

Payment Due in Full at the Time of Service:

All charges for services rendered are due and payable in full at the time of service, regardless of whether you have insurance. Patients must waive any and all claims against Practice with respect to the processing of insurance claims and the payment of benefits from the insurance company to you. We are out of network with ALL insurance plans except traditional government issued Medicare. We do not participate in managed medicare or medicaid plans. A typical initial medical visit fee is $995 and typical follow up visit fee is $435.

Blood samples are sent to an outside laboratory who may bill your insurance for additional fees. Acceptable payment methods include cash, credit card or check.

Returned Check Policy:

If a payment is made on an account by check, and the check is returned as Non-Sufficient Funds (NSF), Account Closed (AC), or Refer to Maker (RTM), the Patient or the Patient’s Responsible Party will be responsible for the original check amount in addition to a $25.00 check service charge. Once notice is received of the returned check, Practice will send out a letter to notify the Responsible Party of the returned check.

If a response is not made within 15 days from the letter date by the Patient or the Responsible Party, the account may be turned over to our collection agency and a collection fee will be added to the outstanding balance – in addition to the $25.00 check service charge.

Missed Appointments and Late Cancellations:

Patients will be charged a fee of up to $500.00 if you miss an appointment or fail to cancel an appointment at least 24 hours prior to your scheduled visit. If you fail to appear for your appointment within 25 minutes after the scheduled time, the appointment will be considered missed without appropriate cancellation and you will be subject to a fee of $500.00. You must pay this balance in full at the time of your next appointment.

Non-Payment on Account:

Should collection proceedings or other legal action become necessary to collect an overdue account and missed appointments/late cancellations, the Patient or the Patient’s Responsible Party understands that Practice has the right to disclose to an outside collection agency all relevant personal and account information necessary to collect payment for services rendered.

The Patient, or the Patient’s Responsible Party, understands that they are responsible for all costs of collection including, but not limited to, interest due at a 18% per annum (or the highest rate permitted by law, if lesser), all court costs and attorneys’ fees, and collection fees, which will be added to the outstanding balance.

Location

Sarah Fishman MD PhD PC
133 East 58th St, Suite 1403
New York, NY 10022
Phone: 212-729-8663
Fax: 212-729-8931

Office Hours

Get in touch

212-729-8663