West Ridge OBGYN
You may download and print any of the office forms listed below. Your completed forms can either be brought to the office at the time of your visit or fax them to us prior to your appointment. To view the forms listed below, you will need Adobe Reader.
You may download Adobe Reader for free at www.adobe.com.
- Patient Registration Form
- Consent for Release of Medical Information
- NYS Disability Claim Form (DB-450)
- Request for Restriction on Use/Disclosure of Medical Information
- RHIO Patient Consent Form
We participate with many local and national insurance plans, but it is your responsibility to understand whether your insurance has limits on the doctors you can see, or the services you receive. Insurance plans are negotiated between insurance companies and employer groups, therefore everyone's medical coverage is not the same. Individual coverage may require co-insurance, co-pays, or deductibles. We require that these amounts due be paid at the time of service, as per your insurance carrier contract. Please bring your current insurance card to every office visit so that we may verify your insurance coverage.
Our practice currently participates with the following insurance plans:
- Aetna US HealthCare
- Excellus BlueCross BlueShield
- Preferred Care
- MultiPlan / PHCS
- MVP Healthcare (formerly Preferred Care)
- United Healthcare
- Univera Healthcare
Non-Participating Insurance Companies
We participate with most insurance carriers. If we do not participate with your insurance company, we will submit claims for you as a courtesy. If the insurance company does not pay within 45-days, you will be responsible for payment of all charges.
In the event that your health insurance plan determines a service to be "not covered", you will be responsible for the complete charge. Should this occur, we will bill you and payment is due upon receipt of that statement.
Co-pays, Deductibles and Co-Insurance are a contract between you and your insurance carrier, and are due at the time of service. Some contracts require more than one co-pay on the same date of service if you have two different types of exams or procedures done. If your co-pay is not paid at the time of service, there will be a $15 billing fee added to your charge unless prior arrangements have been made with our office.
If your insurance requires pre-approval or referrals to our practice, it is your responsibility to make sure that referral has been made.
We will complete one set of insurance forms for you. Please allow 7-10 business days for completion of disability, compensation or insurance forms.
Please speak with our billing staff if you have any questions about your account. We want to work with you to avoid any financial problems and to assure that your account remains in good standing. Please contact our billing office if you have any financial questions or concerns about your account at (585) 225-1580 option 5.