If you choose to have a visit here, knowing you have not changed your PCP, to Dr Ali Tabarroki , you will be responsible for the entire visit. You have been advised at check in that the name on the card differs. If your insurance requires referrals/authorizations it’s your responsibility to provide the name, address, phone number, and NPI number of the facility. Referrals/authorizations must be in place before your visit. Please allow 48 hours for your request to be placed.
It is the responsibility of the patient to be aware of the contract benefits of his/her medical insurance carrier. This may include copayments, deductibles, x-rays and diagnostic testing. We believe in providing the highest quality of care at the time of your visit. Some insurances require tests to be performed at outside facilities, require prior authorization, or services that are not covered at this facility at the time of your visit. This includes lab testing, blood work, imaging studies (x-rays), immunizations and injections. Please be aware of your plans’ requirements and let the provider know, otherwise you may be responsible for charges not covered by your insurance. By signing below, I acknowledge that I may receive a copy of High Horizon/ West Hempstead Primary Care’s Notice of Privacy Practices, Referral Requirements and Patient Financial Responsibility statement upon request. I have read and understand the High Horizon/West Hempstead Primary Care’s Notice of Privacy Practices, Referral Requirements and Patient Financial Responsibility statement and I have had an opportunity to ask questions about the use and disclosure of my health information, and other concerns regarding my health information.
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