380 2nd Ave Suite 1004, New York, NY 10010 | tel: (212) 224-9555

Information for Out –of-Network Services: Health Care Plan Information and Patient Financial Responsibility

Thank you for choosing Pain Management NYC, PLLC (the “Practice”) as your healthcare provider. We are honored by your choice and are committed to provide you with the highest quality healthcare. We ask that you read and sign this form to acknowledge your understanding of out-of-network (“OON”) services and your patient responsibilities for OON services.

Insurance Participation:

Attached to this form is a list which sets forth the health care plans and/or products in which the Practice and its pain doctors, physicians and physician’s assistants participate. The list also includes the hospital affiliations of our physicians. You may also access this information on our website at painfreenyc.com

Out –of –Network Services:

Prior to your first office visit, we will contact your health care plan to verify your OON benefit coverage.

As a courtesy, we will submit all claims to health care plans for the services we provide. If the Practice and physician doesn’t participate in your health care plan or product, you may incur higher out-of-network expenses for OON services than you would incur for services provided by in-network provider.

If we are OON, you may request information about the estimate amount that the Practice will bill for the OON services (absent unforeseen medical circumstances). To request information about these estimated costs, please contact our Billing Department at (212) 224-9555/or fax your inquiries to 718-998-9891. You may also contact our Billing Department with questions about our financial policies.

Patient Responsibility:

You are required to provide us with the most correct and updated information about your health care plan coverage. You are responsible for the payment of your deductible and/or co-insurance and any other amount that your health care plan may not cover.

Payment for OON services is due at the time of the service. For your convenience, we accept cash, checks and most major credit cards at our office. Any and all amounts for which you are responsible may be subject to collection efforts consistent with applicable law, rules and regulations. You may also be responsible for additional amounts, including, but not limited to: charges for returned/bounced checks; charges for missed appointments without 24-hours’ notice; and any costs associated with the collection of your outstanding balance.

If you have any questions about your financial responsibility, you may contact our Billing Department at (212) 224-9555.

This page was published on Dec 9, 2019, modified on Dec 9, 2019 by Dr. Leon Reyfman, MD (Pain Management Doctor) Leon Reyfman, MD | Interventional Pain Management Doctor in New York City

Leon Reyfman, MD, is a top-rated, best-in-class interventional pain management doctor. He is a nationally recognized pain relief specialist and is among the top pain care doctors in New York City and the country. He is an award-winning expert and contributor to prominent media outlets.

Dr. Leon Reyfman has been recognized for his thoughtful, thorough, modern approach to treating chronic pain. He has been named a "top pain management doctor in New York" and one of "America's Top Doctors™" for advanced sports injury treatments. Among other accolades, he was voted by peers as a "Castle Connolly Top Doctors™" and "New York Super Doctors™". Dr. Leon Reyfman was a part of the medical team at the 2016 Summer Olympic Games in Rio de Janeiro, Brazil.

Pain Management NYC
380 2nd Ave Suite 1004
New York, NY 10010
(btw 21st and 22nd Street)
(212) 224-9555

The information on this website is to provide a general information. In no way does any of the information provided reflect a definitive treatment advice. It is important to consult a best in class pain management specialist in NYC regarding ANY questions or issues. A thorough evaluation should ALWAYS be performed for an accurate diagnosis and treatment plan. Be sure to call your pain doctor in Manhattan, to schedule a consultation.

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