Notice of Health Care Plan Participation, Hospital Affiliations, and Coordination of Care/Referrals to Other Health Care Providers
I hereby acknowledge the following:
I have received this notice from Manhattan Gastroenterology, PC d/b/a Manhattan Specialty Care (the “Practice”) of the health care plans in which the Practice and all Practice physicians and other practitioners are participating providers, as well as the hospital affiliation(s) of all Practice physicians/practitioners, set forth in Appendix A.
I am aware that I can find up-to-date information about my physician’s/practitioner’s health care plan participation and hospital affiliation(s) on the Practice’s website at mscnyc.com.
I am aware that some of the Practice’s services are provided on an out-of-network basis.
Physician Services. I acknowledge that I have been made aware that certain physicians as well as anesthesiologists of the Practice may not participate in my health care plan. I understand that if I receive services from a non-participating physician, I may be financially responsible for certain out-of-pocket costs that my health care plan does not cover.
Radiology and Laboratory Services. I am aware that the Practice has an in-office laboratory and that the Practice can perform certain laboratory testing, which may be provided on an out-of-network basis. Further, I am aware that the Practice performs certain radiology services (for example, ultrasounds) which may be on an out-of-network basis. I am aware that, to the extent my physician/practitioner refers a specimen to the Practice’s in-house laboratory or performs radiology test(s) at the Practice, I may be responsible for certain out-of-pocket costs that my healthcare plan does not cover. I am aware that I may request that the Practice refer my specimen(s) to an outside lab and/or refer me to another radiology provider that does participate in my health care plan.
In connection with the Practice’s out-of-network physician services, anesthesiology services, radiology services and/or laboratory services, I am aware that I may request an estimate of the amount of charges for these services by calling the Practice, and upon such request, I will receive a written estimate of the charges that I will be billed for the service(s) (absent unforeseen medical circumstances that may arise).
I acknowledge that my physician/practitioner may coordinate with or refer to other health care providers for certain anesthesiology, laboratory, pathology, radiology and/or assistant surgeon services. I acknowledge that the Practice has provided me with the names, addresses and phone numbers of these other health care providers, as set forth in Appendix B of this notice, and that I may contact these health care providers to find out if they participate in my health care plan or product.
If I have any questions about the Practice’s health care plan participation, my physician’s/practitioner’s health care plan participation, billing questions, or if I would like to request information about the estimated charges for out-of-network services, I can call (212) 427-8761.
Physician Health Care Plan Participation and Hospital Affiliations
Manhattan Gastroenterology, PC d/b/a/ Manhattan Specialty Care/Manhattan Eye Specialists/Manhattan/Manhattan Primary Care/Manhattan Health & Wellness/Manhattan Foot Specialists/Manhattan Dermatology Specialists
GI Physicians: Dr. Dann/Dr.Lee/Dr.Yoon/Dr.Perl/Dr.Schwartz/Dr.Yakubov/Dr.Rao
Hospital Affiliation: NYP/Weill Cornell Medical Center
Health Care Plan Participation: Aetna, Blue Cross, Cigna, GHI, Oxford, UHC
Primary Care Physician: Dr.Rodriguez and Gynecology Physician: Dr. Mariz
Hospital Affiliation: Mount Sinai Medical Center
Health Care Plan Participation: Aetna, Blue Cross, Cigna, GHI, Oxford, UHC
Dermatology Physician: Dr.Bard- Health Care Plan Participation: Blue Cross Blue Shield (BCBS) Cigna, Medicare. Hospital Affiliation: NYP/Weill Cornell Medical Center
Optometry: Dr. Saba Khodadadian and Podiatry: Dr. Rimawi
Health Care Plan Participation: None. Hospital Affiliation: None.
GI: Dr. Shawn Khodadadian- Health Plan Participation: None
Hospital Affiliation: NYP/Weill Cornell Medical Center
Laboratory Services:
Quest Diagnostics, LabCorp, P4 Diagnostics Laboratory Network, Pathnostics, Genesis Laboratory amongst others as needed
Manhattan Gastroenterology, P.C. Blood Laboratory- Health Plan Participation:None
Pathology Services: P4 Diagnostics Laboratory Network
Manhattan Gastroenterology, P.C. CLIA Pathology Lab-Health Plan Participation:None
Pathologists-Dr. Calvin Strand, Dr.Maria Sabatini, Per Diem Pathologists as needed
Anesthesia- Dr. Irena Alexeyeva, Dr.Howard Reynolds, Per Diem as needed for scheduling-
Health Care Plan Participation: None
Manhattan Specialty Care, dba Manhattan Infusion Center, Health Care Plan Participation: None
Radiology Services: Lenox Hill Radiology, NYU Langone, Other facilities as needed
Manhattan Gastroenterology, P.C dba Advanced Radiology Services: Health Care Participation: None
Radiology Physicians: Dr. Daniel Shifteh/Dr.Maklansky as reading physicians. Health Plan Participation: None
If laboratory services are done by a third party having no affiliation, with our practice, you may receive a bill directly. As these are outside services, Manhattan Specialty Care does not have access to these claims and can not assure how they are processed. In such cases, patients must reach out to these entities directly. If you would like further or up to the minute information about a physician’s or service’s participation, please call your insurance company to verify as these can change from time to time.
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