- Full name of you and the insured if not yourself
- Date of Birth
- Primary Contact Telephone Number
- Health Insurance Identification Number
Currently we are not listed with any insurance panels as an “in-network provider”.
Fees and Insurance: We accept the PPO out of network portion for United Health Care, Blue Cross Blue Shield or Empire Blue Cross, BCBS, Oxford , Cigna, Meridian, Aetna, Value Options, Ghi. If you have a PPO with one those plans, office will manage the billing process with your insurance company.
If you intend to use insurance YOU MUST SEND A DIGITAL PHOTO of the FRONT and BACK of your card in advance of your visit:
BY REGULAR MAIL
Dr. Jayme Albin
120 East 56th Street
New York, NY 10022
VIA EMAIL: email@example.com
For your convenience you may upload and attached these images on the Scheduling Form, located on the SET UP APPT. tab in this section.
Please note: You will be financially responsible for your deductible and co-insurance for each visit. To find out what your deductible and co-insurance will be please email to: firstname.lastname@example.org the following information:
Please not THE CUSTOMER SERVICE phone number on your card.
If you have a plan other than the ones listed, you will be directly responsible to pay at the time of your visit and you will receive a receipt of services for submission to your insurance company. For patients who do not have any insurance or out of network insurance, sliding fee scale rates are available.