We Are A Center For Chronic Adult Care Disease Management
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Care Center of Lake Placid receive payment for patient care from insurance companies, Medicare, and/or other third party program
Permission to Communicate with Your Primary Care Physician and/or Other Community Care Providers: In order to ensure continuity of care, it is often necessary to communicate information to your primary care physician, other community care provides and to your insurance company. These communications may include information about your medical treatment and mental health or substance abuse treatment. This information is limited to that of which is necessary to the determination of coverage and the coordination of your care. Many insurance companies require us to document whether or not you will allow your clinician to communicate with your primary care physician and/or Health Insurance Company.
DISCLAIMER: By typing your name below, you are signing this form electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.
Due to the many constant changes in Insurance policies, we are not able to predict what an insurance will or will not cover. Many Insurances only allow members to use a particular "in network" lab, have tests done as special "in network" facilities and go to "in network specialist doctor.
Your Contract is between you and the insurance company. Please call you insurance and learn more about your coverage. Make sure that the lab work tests to be done are covered by your insurance company, that the facility and/or doctor you are going to is "In network for your Insurance. It will save a confusion. Failure to do this could result in you being responsible for all cost incurred (doctor visit, lab work, test) during your visit with our office or other office/facility.
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