Insurance & Hospital Participation

Information for Out-of-Network Services: Health Care Plan Information and Patient Financial Responsibility

Thank you for selecting Neuro Injury Specialists (the “Practice”) as your healthcare provider. We appreciate your trust and are dedicated to offering you top-quality care. Please take a moment to read and sign this form, which explains out-of-network (OON) services and outlines your responsibilities as a patient regarding these services.

Insurance Participation:

A list is attached to this form detailing the healthcare plans and products that the Practice, along with its pain doctors, neurologists, physicians, and physician assistants, participates in. It also includes the hospital affiliations of the Practice’s physicians. You can also find this information on our website at neuroinjuryspecialists.com

• Dr. Leon Reyfman
• Dr. Dmitriy Dvoskin
• Dr. Mark Cohen

Out–of–Network Services:

Before your first office visit, we will verify your out-of-network (OON) benefit coverage with your healthcare plan. As a courtesy, we submit all claims for services provided. If the Practice or physician is out of network, you may face higher OON costs compared to in-network services. You can request an estimate of the charges for OON services, barring unforeseen medical situations, by contacting our Billing Department at (718) 998-9899 or via email at info@neuroinjuryspecialists.com. Feel free to reach out for any billing or financial policy inquiries.

Patient Responsibility:

You are responsible for providing accurate and up-to-date information about your healthcare coverage. Payment for out-of-network services, including deductibles or co-insurance, is due at the time of service. We accept cash, checks, and major credit cards. Any unpaid balances may be pursued through collection efforts in accordance with laws and regulations. Additional fees may apply for returned checks, missed appointments without 24-hour notice, and collection costs. For questions about your financial obligations, please contact our Billing Department at (718) 998-9899.