(Patient name) and (health benefits plan)

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• New Jersey Vein & Cosmetic Surgery Center is in-network for the health benefit plans named in the insurance tab of the Patient Resources section on this website. Your financial responsibility to this facility will be no greater than your in-network copayment, deductible, and/or coinsurance amount.

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• You should contact the health care professional, such as your doctor, or the physician assistant or advance practice nurse who ordered the services, to determine if they are in-network or out-of-network for your health benefits plan. Since we do not have a website, a paper copy of the insurance policies we participate in will be given to you upon request.

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In some cases, health care professionals other than the one ordering the service may provide and bill for care in this facility. You can expect for services to be provided by:

 

Harold Mast, MD

Richard Shoenfeld, MD

741 Northfield avenue, suite 105

West Orange, NJ 07052

 

Drs. Anesthesia, LLC.

35 Library Place

Edison, NJ 08820

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• If you receive any bills from in-network providers for more than your in-network copayment, deductible, and/or coinsurance amount, you should report this information to your insurance carrier and, if the bill is from New Jersey Vein & Cosmetic Surgery Center to the Department of Health at (800) 792-9770. If the bill is from a health care professional, you should report this information to the appropriate professional licensing board in the Division of Consumer Affairs, Department of Law and Public Safety at (973) 504-6200.

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The amount you owe an in-network provider will not be more than any in-network copayment, deductible, coinsurance amount per your health benefits plan.

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• If you specifically select an out-of-network provider, you will be asked to sign an acknowledgement of out-of-network provider services, which may exceed your in-network copayment, deductible, and/or coinsurance amount.

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• You should contact your health benefits plan for information regarding your copayment, deductible and/or coinsurance amount. Contact information is typically found on the card provided to you by your health benefits plan.

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• New Jersey Vein & Cosmetic Surgery Center staff will notify you in the event the in-network status of New Jersey Vein & Cosmetic Surgery Center changes before services are provided.