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Non-Discrimination Notice

Financial Policy

Policy Statement: Financial Policy for Associated Medical Professionals of NY, PLLC

Purpose: Associated Medical Professionals of NY, the physicians, providers, and staff are dedicated to providing the best possible care for you. We value the trust and responsibility you place in us to provide you with the most quality care. We want to ensure that our financial policies are clearly presented and understood by you. If you have any questions regarding our financial policies, please contact our billing office at 315-870-9370 (option #1).

Patient Responsibility: It is your responsibility to know your insurance benefits to ensure that we participate with your insurance carrier and whether you require a referral from your PCP or not. Our office cannot always tell you in advance whether or not your charges will be covered by your insurance plan. Each insurance company has multiple plans that can vary with employer group contracts. Since your coverage is a contract between you and your insurance carrier, we expect you to be aware of services that may not be covered under your contract. It will be your responsibility to pay for the bill if the service was already rendered.

You must present your insurance card(s) at each visit. We will also have to maintain a copy of your driver's license on file. Failure to provide valid insurance information to us prior to your visit may result in payment in full at time of service or in the event the insurance is denied due to inaccurate information that was provided.

If we do not participate with your insurance company, or you do not have insurance, please contact our Billing Dept. at 315-870-9370 (option #1) to request an estimate of your services.

Appointments: We ask that you appreciate the fact that if you miss or cancel an appointment at the last moment, AMP will be unable to fill your time slot with another patient who needs an appointment. (You would expect the same consideration when you have an urgent problem and need us to see you.) Therefore, if you need to cancel or re-schedule your appointment, we ask you to give us the required notice listed below. If you fail to give us such notice, we will charge you a no-show fee (which is not covered by insurance). Excessive abuse of the scheduled appointments (no shows, chronic lateness, etc.) may result in discharge from the practice.

Reason/Appointment Type Notice Period Required Fee
No show, cancellation or reschedule/Office Visit 24 hours $50.00
No show, cancellation or reschedule/Office Procedure 24 hours $100.00
No show, cancellation or reschedule/Office Procedure with Anesthesia 24 hours  $200.00
No show, cancellation or reschedule/Hospital Procedure 48 hours $200.00

Copays, coinsurance, and deductibles: As part of your contract with your insurance carrier, all co-payments are required at the time of service. In addition, you are responsible for all coinsurance and deductibles. Failure to do so may result in termination of your insurance. For your convenience, we do accept cash, personal or bank checks, money orders, and all major credit cards. All returned checks will be charged a $25.00 processing fee.

Collections: Patients who do not make reasonable progress toward resolving outstanding debt to the practice may be turned over to our collection agency. If this occurs, you will be responsible for the outstanding balance due to our practice. Accounts with a balance over 30 days will be assessed a 1.25% rate charge per month on the unpaid monthly patient balance. In addition, you may be responsible for any attorney fees in addition to the balance.

Insurance, Disability, or Miscellaneous Forms: Forms are $30 for the first form and $15 for each additional form turned in at the same time. MediCopy will send an invoice and forms cannot be completed prior to payment. Please provide an email address if available as this will expedite the process.

Surprise Act

New York State implemented a bill to protect health care consumers who obtain services from out of network physicians.

As a health care consumer you have the right to:

  1. To request an estimate of your services. You may contact the AMP billing Dept. at (315) 870-9370 (option #1) to request a written estimate.
  2. On the AMP website there is a list of AMP's affiliations names and address if you are referred out for testing to see if they participate with your insurance company or not, also if you need to request an estimate from these other affiliations.
    Go to the AMP website: www.ampofny.com - under New Pt - under Affiliations lists.

It is important that you understand our Financial Policy. Please feel free to contact us with any questions prior to your appointment.

I have read and understand the practice's financial policy and I agree to be bound by its terms. I also understand and agree that such terms may be amended by the practice from time to time.

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