Scheduling Your Appointment
Thank you for choosing UB Neurosurgery for your neurosurgical consultation. To schedule an appointment at any of our offices, please call us at 716/218-1000, for our pediatric neurosurgery office, please call 716/878-7386.
Your Initial Visit
Our physicians and staff would like to welcome you to our practice. To ensure we have the information required to see you, we will need the following:
- Complete the Patient Information packet that you will receive in the mail and bring it with you on the day of your appointment. If you would like to download the form, print it out and bring it to your appointment, please click here.
- Please bring your actual x-rays/films and/or CD imaging films and your written report if not done at a Kaleida or Dent facility.
- Bring a list of all current medications.
- Bring your insurance cards.
- Bring your co-pay. Please Note: Our practice does accept both credit and debit cards for your convenience.
- Obtain an insurance referral if required by your insurance carrier. (Check the front of your insurance card or call the back of your card if you are unsure).
- If you are under the age of 18, you must be accompanied by a parent or guardian.
- Prior to your visit, please make arrangements for an interpreter if needed.
- If this is a worker’s compensation case (work-related injury), please fill out the entire Worker’s Compensation section of the Insurance Coverage form. Also, please bring your Notice of Case Assembly letter if you’ve received this from the WC Board as it contains important information. Please Note: Your appointment will be rescheduled if we do not receive full insurance information by or at the time of the appointment.
- Due to the length of our waiting list, please give 24-hour notice if you must reschedule or cancel your appointment to avoid a $25 no-show fee. We thank you for giving us the opportunity to participate in your care.
- *As teaching faculty, UB Neurosurgery physicians have teams of providers with expertise in neurosurgical disorders that assist them. These include residents and fellows as well as nurse practitioner and physician’s assistants. At your appointment, a nurse practitioner or physician assistant who specializes in neurosurgery may see you. They will confer with your physician regarding your progress as needed. This is a team effort with the best interest of our patients in mind.
- UBNS provides the treatment that is best suited to your diagnosis and individual situation. We are committed to developing and evaluating innovative treatments; whenever appropriate, you will be offered the opportunity to participate in clinical trials and research studies of promising new therapies.
Patient Care Statement
We are committed to providing you with the best care, and we are happy to discuss our professional fees with you at any time. Your clear understanding of our financial policy is important. Please ask if you have any questions about our fees, financial policy, or your responsibilities. UBNS contracts with most of our local carriers – please call our office to check if in doubt.
At the time of service, it is your responsibility to provide UBNS with the following documentation:
- Patient’s social security number - due to the implementation of new eligibility verification systems. In accordance with HIPAA regulations, we maintain the right to request SS#; however, you have the right to decline to give the information.
- Patient’s current insurance card – with complete id numbers and billing address
- Workers’ Compensation or No Fault Carrier - WCB# or NF policy#, complete claims address – If you do not have this information at time of your visit, you will be asked to reschedule your appointment until this information is received at our office.
- Copayment – copayment is required at the time of your visit. If you do not have your copayment at time of visit, you will be asked to reschedule your appointment.
At the time of your visit, our secretary will ask you to verify the above information including, but not limited to, confirming our current address, phone number and pharmacy number. Our secretary will also collect any applicable copays at time of service and any balances due. These expenses are part of a contract between you and your carrier and cannot be legally waived by our practice.
If we find that you will incur any out of network fees which may include any insurance carriers we are not contracted with, your patient liaison representative will contact you to discuss your self-pay fees and/or payment options that are available. For your convenience, our office accepts cash, personal checks, money orders, Visa and MasterCard.
Authorization for Medical Treatment
University at Buffalo Neurosurgery, Inc. (“UBNS”) physicians, professionals and other personnel are hereby authorized to administer any medical, diagnostic or therapeutic treatment, as may be deemed necessary or advisable. I have the right to consent or refuse consent, to any proposed procedure or therapeutic course, absent emergency or extraordinary circumstances.
Disclosure of Information
I understand that my medical records and billing information are made and retained by UBNS and are accessible to office personnel. UBNS personnel may use and disclose medical information for operations, functions and to any other physician or health care personnel involved in my continuum of care. Safeguards are in place to discourage improper access. UBNS and its medical staff are authorized to disclose all or part of my medical record to any insurance carrier, workers’ compensation carrier, or self-insured employer group liable for any part of UBNS’s charges and to any health care provider who is or may become involved with my care.
Assignment of Insurance Benefits
I agree the physician benefits otherwise payable to the insured are to be made to the physician(s) responsible for my care. Any payment received for the period may be applied to any unpaid bills for which I am liable, subject to the rules of coordination of benefits. Refusal to authorize assignment of benefits will require payment in full by cash, check or credit card at the time of service in accordance with UBNS Financial Policy.
Insurance Coverages; Notice of Non-Coverage
I understand that UBNS will assist with insurance precertification requirements, but will not assume responsibility for precertification or any impact which it may have on insurance payment. Consistent with the terms of our agreements with various health plans and insurers, in the event that UBNS is notified in advance that an item or service will not be covered by a health plan or insurer, UBNS will notify you of non-coverage and your responsibility for payment and your right to appeal the notice of non-coverage consistent with the terms of your health plan and applicable law.
Financial Responsibility and Patient Financial Policy
As consideration for the services provided, I (the patient or responsible party) agree to make payment for any amount due for such services provided by UBNS as determined by UBNS in accordance with its Patient Financial Policy. If I have available insurance coverage, I agree to make payment for any amounts that are not paid for by my insurance policy, including copays, coinsurance, deductibles and amounts subject to exclusions or limitations or otherwise not covered by the policy. I acknowledge that UBNS has provided me the attached Schedule of Services with an estimate of required services and supplies and I agree to make payment of these amounts to the extent that third party insurance coverage is not available in accordance with the payment schedule set forth in the attached estimate. In addition, I understand that the attached schedule is an estimate, is subject to change consistent with the Patient Financial Policy based upon the actual care (including services and supplies) received by me, and I will be financially responsible for the actual services and supplies provided by UBNS.
Appointment Cancellation Policy
We require a 24-hour notice of cancellation for all scheduled appointments. If you fail to notify our office, you will be charged a $50.00 no-show fee.
- You will receive a billing statement for balances that are not paid. Payment is expected upon receipt of statement. Accounts with outstanding balances will be forwarded to our collection agency after the 4th mailed notification.
- If unusual circumstances make it impossible for you to meet the terms of this financial policy, please do not hesitate to discuss your account further with our billing office by calling (716) 218-1030, option #1. This will avoid any misunderstandings and enable you to keep your account in good standing while providing the care you need.