{"id":1482,"date":"2021-07-30T11:08:47","date_gmt":"2021-07-30T11:08:47","guid":{"rendered":"https:\/\/www.toplinemd.com\/masfdocs\/?page_id=1482"},"modified":"2024-10-16T19:33:05","modified_gmt":"2024-10-16T19:33:05","slug":"patient-information","status":"publish","type":"page","link":"https:\/\/www.toplinemd.com\/masfdocs\/patient-information\/","title":{"rendered":"For Patients"},"content":{"rendered":"<p><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container fusion-parallax-none hundred-percent-fullwidth non-hundred-percent-height-scrolling lazyload\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:13%;--awb-padding-bottom:13%;--awb-background-size:cover;--awb-flex-wrap:wrap;\" data-bg=\"https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/Patient-Info-Banner.jpg\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-1 fusion-sep-none fusion-title-center fusion-title-text fusion-title-size-one\" style=\"--awb-margin-top-small:0px;--awb-margin-right-small:0px;--awb-margin-bottom-small:20px;--awb-margin-left-small:0px;\"><h1 class=\"fusion-title-heading title-heading-center\" style=\"margin:0;\">Patient Information<\/h1><\/div><div class=\"hero-button\">\n<a class=\"invert-btn\" href=\"tel:+13058882607\"><i class=\"fas fa-phone-alt\"><\/i> (305) 888-2607<\/a>\n<a href=\"\/masfdocs\/patients-information-english\/\"><i class=\"far fa-calendar-check\"><\/i> Book Appointment<\/a>\n<a href=\"\/masfdocs\/patients-information-spanish\/\"><i class=\"far fa-calendar-check\"><\/i> Programar una cita<\/a>\n<\/div>\n<\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-2 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:5%;--awb-padding-bottom:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1289.6px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-2 fusion-sep-none fusion-title-text fusion-title-size-two\" style=\"--awb-margin-bottom:15px;--awb-margin-top-small:0px;--awb-margin-right-small:0px;--awb-margin-bottom-small:20px;--awb-margin-left-small:0px;\"><h2 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Important Forms<\/h2><\/div><div class=\"fusion-text fusion-text-1\"><p>Feel free to take the time and complete our forms prior to your initial visit. Our forms are available in a printer friendly version.<\/p>\n<p><a href=\"\/masfdocs\/patients-information-english\/\">Registration Form (English)<\/a><\/p>\n<p><a href=\"\/masfdocs\/patients-information-spanish\/\">Registration Form (Spanish)<\/a><\/p>\n<p>Medical Record Release Form (English Only)<\/p>\n<\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;margin-top:5%;margin-bottom:5%;width:100%;max-width:100%;\"><div class=\"fusion-separator-border sep-single sep-solid\" style=\"--awb-height:20px;--awb-amount:20px;--awb-sep-color:#ebebeb;border-color:#ebebeb;border-top-width:1px;\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-3 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1289.6px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-padding-bottom:30px;--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-3 fusion-sep-none fusion-title-text fusion-title-size-two\" style=\"--awb-margin-bottom:0px;--awb-margin-top-small:0px;--awb-margin-right-small:0px;--awb-margin-bottom-small:20px;--awb-margin-left-small:0px;\"><h2 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\"><p style=\"text-align: center\">Insurances We Accept<\/p><\/h2><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-3 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-image-carousel fusion-image-carousel-fixed fusion-image-carousel-1\"><div class=\"awb-carousel awb-swiper awb-swiper-carousel awb-carousel--carousel awb-swiper-dots-position-bottom\" data-layout=\"carousel\" data-autoplay=\"yes\" data-autoplayspeed=\"2500\" data-autoplaypause=\"no\" data-loop=\"yes\" data-columns=\"5\" data-columnsmedium=\"1\" data-columnssmall=\"1\" data-itemmargin=\"10\" data-itemwidth=\"180\" data-touchscroll=\"drag\" data-freemode=\"no\" data-imagesize=\"fixed\" data-scrollitems=\"0\" data-centeredslides=\"no\" data-rotationangle=\"50\" data-depth=\"100\" data-speed=\"500\" data-shadow=\"no\" data-pagination=\"bullets\" style=\"--awb-column-spacing:10px;\"><div class=\"swiper-wrapper awb-image-carousel-wrapper fusion-flex-align-items-center\"><div class=\"swiper-slide\"><div class=\"fusion-carousel-item-wrapper\"><div class=\"fusion-image-wrapper hover-type-none\"><img decoding=\"async\" width=\"233\" height=\"102\" src=\"https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/BCBS.png\" class=\"attachment-blog-medium size-blog-medium lazyload\" alt=\"BCBS\" srcset=\"data:image\/svg+xml,%3Csvg%20xmlns%3D%27http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%27%20width%3D%27233%27%20height%3D%27102%27%20viewBox%3D%270%200%20233%20102%27%3E%3Crect%20width%3D%27233%27%20height%3D%27102%27%20fill-opacity%3D%220%22%2F%3E%3C%2Fsvg%3E\" data-orig-src=\"https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/BCBS.png\" data-srcset=\"https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/BCBS-200x88.png 200w, https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/BCBS.png 233w\" data-sizes=\"auto\" \/><\/div><\/div><\/div><div class=\"swiper-slide\"><div class=\"fusion-carousel-item-wrapper\"><div class=\"fusion-image-wrapper hover-type-none\"><img decoding=\"async\" width=\"233\" height=\"102\" src=\"https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/cigna-logo.png\" class=\"attachment-blog-medium size-blog-medium lazyload\" alt=\"cigna-logo\" srcset=\"data:image\/svg+xml,%3Csvg%20xmlns%3D%27http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%27%20width%3D%27233%27%20height%3D%27102%27%20viewBox%3D%270%200%20233%20102%27%3E%3Crect%20width%3D%27233%27%20height%3D%27102%27%20fill-opacity%3D%220%22%2F%3E%3C%2Fsvg%3E\" data-orig-src=\"https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/cigna-logo.png\" data-srcset=\"https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/cigna-logo-200x88.png 200w, https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/cigna-logo.png 233w\" data-sizes=\"auto\" \/><\/div><\/div><\/div><div class=\"swiper-slide\"><div class=\"fusion-carousel-item-wrapper\"><div class=\"fusion-image-wrapper hover-type-none\"><img decoding=\"async\" width=\"233\" height=\"102\" src=\"https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/final-home_30.jpg\" class=\"attachment-blog-medium size-blog-medium lazyload\" alt=\"final-home_30\" srcset=\"data:image\/svg+xml,%3Csvg%20xmlns%3D%27http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%27%20width%3D%27233%27%20height%3D%27102%27%20viewBox%3D%270%200%20233%20102%27%3E%3Crect%20width%3D%27233%27%20height%3D%27102%27%20fill-opacity%3D%220%22%2F%3E%3C%2Fsvg%3E\" data-orig-src=\"https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/final-home_30.jpg\" data-srcset=\"https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/final-home_30-200x88.jpg 200w, https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/final-home_30.jpg 233w\" data-sizes=\"auto\" \/><\/div><\/div><\/div><div class=\"swiper-slide\"><div class=\"fusion-carousel-item-wrapper\"><div class=\"fusion-image-wrapper hover-type-none\"><img decoding=\"async\" width=\"233\" height=\"102\" src=\"https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/Great-West-HC-Logo.png\" class=\"attachment-blog-medium size-blog-medium lazyload\" alt=\"Great-West-HC-Logo\" srcset=\"data:image\/svg+xml,%3Csvg%20xmlns%3D%27http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%27%20width%3D%27233%27%20height%3D%27102%27%20viewBox%3D%270%200%20233%20102%27%3E%3Crect%20width%3D%27233%27%20height%3D%27102%27%20fill-opacity%3D%220%22%2F%3E%3C%2Fsvg%3E\" data-orig-src=\"https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/Great-West-HC-Logo.png\" data-srcset=\"https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/Great-West-HC-Logo-200x88.png 200w, https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/Great-West-HC-Logo.png 233w\" data-sizes=\"auto\" \/><\/div><\/div><\/div><div class=\"swiper-slide\"><div class=\"fusion-carousel-item-wrapper\"><div class=\"fusion-image-wrapper hover-type-none\"><img decoding=\"async\" width=\"233\" height=\"102\" src=\"https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/humana-logo.png\" class=\"attachment-blog-medium size-blog-medium lazyload\" alt=\"humana-logo\" srcset=\"data:image\/svg+xml,%3Csvg%20xmlns%3D%27http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%27%20width%3D%27233%27%20height%3D%27102%27%20viewBox%3D%270%200%20233%20102%27%3E%3Crect%20width%3D%27233%27%20height%3D%27102%27%20fill-opacity%3D%220%22%2F%3E%3C%2Fsvg%3E\" data-orig-src=\"https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/humana-logo.png\" data-srcset=\"https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/humana-logo-200x88.png 200w, https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/humana-logo.png 233w\" data-sizes=\"auto\" \/><\/div><\/div><\/div><div class=\"swiper-slide\"><div class=\"fusion-carousel-item-wrapper\"><div class=\"fusion-image-wrapper hover-type-none\"><img decoding=\"async\" width=\"233\" height=\"102\" src=\"https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/United-HC-Logo.png\" class=\"attachment-blog-medium size-blog-medium lazyload\" alt=\"United-HC-Logo\" srcset=\"data:image\/svg+xml,%3Csvg%20xmlns%3D%27http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%27%20width%3D%27233%27%20height%3D%27102%27%20viewBox%3D%270%200%20233%20102%27%3E%3Crect%20width%3D%27233%27%20height%3D%27102%27%20fill-opacity%3D%220%22%2F%3E%3C%2Fsvg%3E\" data-orig-src=\"https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/United-HC-Logo.png\" data-srcset=\"https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/United-HC-Logo-200x88.png 200w, https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/United-HC-Logo.png 233w\" data-sizes=\"auto\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-text fusion-text-2\"><p style=\"text-align: center\">Below is a list of our currently accepted insurance plans. Please note that the accepted plans may vary from month-to-month and from physician-to-physician. Use this list only as a general guideline. It is always best to confirm your plan is accepted when making your appointment.<\/p>\n<\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-4 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-3 insurances-list\"><ul>\n<li>AARP Medicare Advantage from UHC FL-0031 (Regional PPO)<\/li>\n<li>AARP Medicare Advantage Patriot No Rx FL-MA01 (Regional PPO)<\/li>\n<li>Aetna HMO, POS, PPO<\/li>\n<li>Avmed<\/li>\n<li>BCBS Blue Care<\/li>\n<li>BCBS Blue Options<\/li>\n<li>BlueCross PPO, POS, HMO<\/li>\n<li>Cigna IFP<\/li>\n<li>Cigna HMO, POS PPO<\/li>\n<\/ul>\n<\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-5 fusion_builder_column_1_2 1_2 fusion-flex-column insurances-list\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-4\"><ul>\n<li>Doctors Health (Medicare)<\/li>\n<li>Great West (ONE Health) HMO, POS PPO<\/li>\n<li>Medicare<\/li>\n<li>MultiPlan PPO<\/li>\n<li>Oscar<\/li>\n<li>PHCS Open Access<\/li>\n<li>United Healthcare<\/li>\n<\/ul>\n<\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-6 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;margin-top:5%;margin-bottom:5%;width:100%;max-width:100%;\"><div class=\"fusion-separator-border sep-single sep-solid\" style=\"--awb-height:20px;--awb-amount:20px;--awb-sep-color:#ebebeb;border-color:#ebebeb;border-top-width:1px;\"><\/div><\/div><div class=\"fusion-text fusion-text-5\"><p style=\"text-align: center\"><strong>Thank you for choosing us as your health care provider. We are committed to providing you the highest level of care. The following is a statement of our Financial Policy that we require you to read and sign prior to any treatment. Unless you are a member of one of our contracted insurance plans or Medicare, full payment is due at the time of service. We accept cash, checks, Visa, MasterCard, Discover and American Express.<\/strong><\/p>\n<\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-4 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:3%;--awb-padding-bottom:3%;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1289.6px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-7 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-padding-bottom:3%;--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-4 fusion-sep-none fusion-title-text fusion-title-size-three\" style=\"--awb-margin-top-small:0px;--awb-margin-right-small:0px;--awb-margin-bottom-small:20px;--awb-margin-left-small:0px;\"><h3 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">POS\/PPO Plans<\/h3><\/div><div class=\"fusion-text fusion-text-6\"><p>If the physician is contracted with your plan, the majority of members covered under this type of plan are still required to make some type of payment for service that is rendered to them. This may be in the form of co-payment, deductible, or co-insurance. If your plan has a co-payment, you will be expected to pay your co-payment prior to being seen by the doctor. Co-payments, deductibles and co-insurance are requirements of your insurance plan and we are required under our contract with these plans to collect these amounts from you.<\/p>\n<\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-8 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-padding-bottom:3%;--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-5 fusion-sep-none fusion-title-text fusion-title-size-three\" style=\"--awb-margin-top-small:0px;--awb-margin-right-small:0px;--awb-margin-bottom-small:20px;--awb-margin-left-small:0px;\"><h3 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">HMO Plans<\/h3><\/div><div class=\"fusion-text fusion-text-7\"><p>Most of the members covered under and HMO plans also owe co-payments. Co-payments will be collected prior to being seen by the doctor. We are required under our contract with these plans to collect these amounts from you.<\/p>\n<\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-9 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-padding-bottom:3%;--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-6 fusion-sep-none fusion-title-text fusion-title-size-three\" style=\"--awb-margin-top-small:0px;--awb-margin-right-small:0px;--awb-margin-bottom-small:20px;--awb-margin-left-small:0px;\"><h3 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Balances on Account<\/h3><\/div><div class=\"fusion-text fusion-text-8\"><p>All previous balances are to be paid in full prior to additional services being rendered.<\/p>\n<p>COLLECTIONS Should it become necessary for us to utilize the services of an outside collection agency in order to collect the amounts that are owed, you will be liable for agency\/attorney fees<\/p>\n<\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-10 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-padding-bottom:3%;--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-7 fusion-sep-none fusion-title-text fusion-title-size-three\" style=\"--awb-margin-top-small:0px;--awb-margin-right-small:0px;--awb-margin-bottom-small:20px;--awb-margin-left-small:0px;\"><h3 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Collections<\/h3><\/div><div class=\"fusion-text fusion-text-9\"><p>Should it become necessary for us to utilize the services of an outside collection agency in order to collect the amounts that are owed, you will be liable for agency\/attorney fees.<\/p>\n<\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-11 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-padding-bottom:3%;--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-8 fusion-sep-none fusion-title-text fusion-title-size-three\" style=\"--awb-margin-top-small:0px;--awb-margin-right-small:0px;--awb-margin-bottom-small:20px;--awb-margin-left-small:0px;\"><h3 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;\">Assignment of Benefits and Medical Record Release<\/h3><\/div><div class=\"fusion-text fusion-text-10\"><p>I hereby authorize my insurance benefits to be paid directly to the above-signed physician realizing I am responsible to pay non-covered services and I hereby authorize the release of pertinent medical information to insurance carriers. Furthermore, I understand and acknowledge that I am ultimately responsible for the financial liability of the services provided.<\/p>\n<\/div><div class=\"fusion-text fusion-text-11 custom-quote\"><blockquote>\n<p>Physicians are members of the medical staff at Mount Sinai Hospital, but are independent contractors who are neither agents nor employees of Mount Sinai; and, as a result, Mount Sinai Hospital is not responsible for the actions of any of these physicians in their medical practices.<\/p>\n<\/blockquote>\n<\/div><\/div><\/div><\/div><\/div><div class=\"fusion-bg-parallax\" data-bg-align=\"center center\" data-direction=\"up\" data-mute=\"false\" data-opacity=\"100\" data-velocity=\"-0.3\" data-mobile-enabled=\"false\" data-break_parents=\"0\" data-bg-image=\"https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/Call-to-action.jpg\" data-bg-repeat=\"false\" ><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-5 fusion-flex-container fusion-parallax-up nonhundred-percent-fullwidth non-hundred-percent-height-scrolling lazyload\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:5%;--awb-padding-bottom:5%;--awb-background-size:cover;--awb-flex-wrap:wrap;\" data-bg=\"https:\/\/www.toplinemd.com\/masfdocs\/wp-content\/uploads\/sites\/251\/2021\/07\/Call-to-action.jpg\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1289.6px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-12 fusion_builder_column_3_4 3_4 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:75%;--awb-margin-top-large:0px;--awb-spacing-right-large:2.56%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:2.56%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-9 fusion-sep-none fusion-title-text fusion-title-size-two white-text\" style=\"--awb-margin-bottom:25px;--awb-margin-top-small:0px;--awb-margin-right-small:0px;--awb-margin-bottom-small:20px;--awb-margin-left-small:0px;--awb-font-size:40px;\"><h2 class=\"fusion-title-heading title-heading-left\" style=\"margin:0;font-size:1em;\">Schedule An Appointment With Us Today<\/h2><\/div><div class=\"fusion-text fusion-text-12 white-text\" style=\"--awb-content-alignment:left;--awb-font-size:16px;\"><p><strong>Conveniently book your appointment with us today. We require all patients to complete the registration prior to their visit. We look forward to serving you!<\/strong><\/p>\n<\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-13 fusion_builder_column_1_4 1_4 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:25%;--awb-margin-top-large:0px;--awb-spacing-right-large:7.68%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:7.68%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div style=\"text-align:center;\"><a class=\"fusion-button button-flat button-xlarge button-custom fusion-button-default button-1 fusion-button-default-span blue-btn-big\" style=\"--button_accent_color:#ffffff;--button_accent_hover_color:#ffffff;--button_border_hover_color:#ffffff;--button-border-radius-top-left:5px;--button-border-radius-top-right:5px;--button-border-radius-bottom-right:5px;--button-border-radius-bottom-left:5px;--button_gradient_top_color:#74ceee;--button_gradient_bottom_color:#74ceee;--button_gradient_top_color_hover:#74ceee;--button_gradient_bottom_color_hover:#74ceee;--button_text_transform:none;\" target=\"_self\" href=\"\/masfdocs\/patients-information-english\/\"><i class=\"fa-calendar-check far awb-button__icon awb-button__icon--default button-icon-left\" aria-hidden=\"true\"><\/i><span class=\"fusion-button-text awb-button__text awb-button__text--default\"> Book Appointment<\/span><\/a><\/div><div style=\"text-align:center;\"><a class=\"fusion-button button-flat button-xlarge button-custom fusion-button-default button-2 fusion-button-default-span blue-btn-big\" style=\"--awb-margin-top:25px;--button_accent_color:#ffffff;--button_accent_hover_color:#ffffff;--button_border_hover_color:#ffffff;--button-border-radius-top-left:5px;--button-border-radius-top-right:5px;--button-border-radius-bottom-right:5px;--button-border-radius-bottom-left:5px;--button_gradient_top_color:#74ceee;--button_gradient_bottom_color:#74ceee;--button_gradient_top_color_hover:#74ceee;--button_gradient_bottom_color_hover:#74ceee;--button_text_transform:none;\" target=\"_self\" href=\"\/masfdocs\/patients-information-spanish\/\"><i class=\"fa-calendar-check far awb-button__icon awb-button__icon--default button-icon-left\" aria-hidden=\"true\"><\/i><span class=\"fusion-button-text awb-button__text awb-button__text--default\"> Programar una cita<\/span><\/a><\/div><\/div><\/div><\/div><\/div>\n<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-6 hundred-percent-fullwidth non-hundred-percent-height-scrolling prim-care1-logos-footer\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:30px;--awb-padding-left:60px;--awb-background-color:#f0f3f6;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-14 fusion_builder_column_1_2 1_2 fusion-one-half fusion-column-first logo-footer\" style=\"--awb-padding-top:40px;--awb-bg-size:cover;width:50%;width:calc(50% - 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