Payment / Office Forms
Accepts new patients
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Insurance plans, payment options, cancellation policy
We participate in:
• Cigna: Open Access & POS ONLY (not PPO)
• United Healthcare (not Oxford or Empire Plan)
• Workers' Compensation, New York State: Requires C-2 Form
• Workers' Compensation, out-of-state: Accepted on a case-by-case basis – please call
For all other insurance plans, full payment is required at the time of service. We will give you a claim form that you can submit to your insurance company for reimbursement. Medicare patients cannot get any reimbursement, as Dr. Weiss has 'opted out' of Medicare.
For braces and splints, please be advised that even if we bill your insurance, the costs of braces and splints are your responsibility. These charges may be subject to a separate co-payment or a separate deductible.
For payment we accept:
Check, Debit Cards, Mastercard, Visa, American Express, Discover
Note: Credit cards not accepted for managed care co-payments.
You must give 24 hours notice if you cannot keep your appointment to avoid being charged a $50 cancellation fee.
Office information and forms
Notice of Privacy PracticesThis document provides information on how my office makes use of your health information and informs you of your rights under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Liability Insurance Crisis
Are you aware that there is a medical liability insurance crisis in New York? Premiums for medical liability insurance have risen so dramatically that patients are at risk of losing their physicians, who will not be able to stay in business if these increases continue. Please read this flyer for complete information.
Map of NYU Langone Medical Center
Dr. Weiss' office is located on the 5th floor of the Schwartz Health Care Center. Use "H" elevators.
Out-Patient Surgery Instructions
These instructions are intended to prepare patients for out-patient surgery at Tisch Hospital-NYU Langone Medical Center ("Day Surgery") or at NYU Hospital for Joint Diseases ("Ambulatory Surgery"). They include pre-operative and post-operative instructions, and information about pre-authorization of surgical procedures.
Patient Information and Medical History Form
You may complete this medical history form (6 pages) before you visit my office for your consultation. Print out a copy (single-sided, please), enter the information (use blue or black pen, please) and bring it to my office at the time of your visit.
Release of Records to Dr. Weiss
This authorization form can be used to request that medical records be sent by other physicians' offices to Dr. Weiss.
Contact Information
www.WeissMD.info
Faculty Practice Offices 530 First Avenue – Suite 5D
Between 31st & 32nd Street
[Use "H" Elevators] New York, NY USA 10016 View map Phone 212-263-7743 Fax 212-263-8810
Office Manager