Forms & Policies
You may download and print any of the forms listed below before coming to our office. You may either bring them with you to your visit or fax them to us before your appointment. To view our forms, you will need Adobe Reader. You may download Adobe Reader for free by visiting www.adobe.com.
- Information for New Patients
- Family Information Sheet
- Transfer Out of the Practice Form
- Transfer INTO the Practice Form
Billing and Insurance
Many people have insurance to cover some, but not all of the cost of your medical care. Most insurance plans require a deductible, co-insurance payment, co-payment or other out of pocket expense, which must be paid by the family or patient. We rely on you to become familiar with your insurance policy and to bring your insurance card with you to each visit. We consider the individual (family member or not) accompanying the child to the office responsible for the payment at the time of service.
Our practice participates with a wide range of area and national carriers; however, there are instances when we are not contracted with your specific insurance carrier or you may not have insurance coverage. If this is the case, 100% of our fees are required to be paid at the time of service. As a courtesy to you, we will file your insurance claim for you for services received so that your insurance carrier reimburses you in a timely fashion. If you have any questions regarding your insurance coverage prior to your visit, please contact your insurance carrier’s member services for an explanation of your healthcare plan.
Many insurance companies require you to select a primary care physician (PCP) prior to being seen for care. If your healthcare plan has this requirement, please be sure you have notified them that you have selected the physician of your choice in our office. It is your responsibility to add a new baby or adopted child to your insurance policy. Insurance claims, which are denied as the result of improper PCP designation, will become your financial responsibility.
Our practice participates in network with the following insurance plans:
Aetna EPO & PPO
Excellus Medicaid Managed Care and Child Health Plus
Out of Area Blue Cross Blue Shield plans (except HMO policies)
Blue Cross/Blue Shield of Western New York
MVP Medicaid Managed Care and Child Health Plus
Fidelis Care NY
Fidelis Care NY Medicaid Managed Care and Child Health Plus
Cigna EPO & PPO
The Empire Plan
United Health Care
UHC Medicaid Managed Care and Child Health Plus
NYS Medicaid (excludes Medicaid out of New York City)
Tricare East EPO & PPO
Lifetime Benefits Solutions
Your Care Medicaid Managed Care and Child Health Plus
Accountable Health Partners