Insurance Information

In order to determine what benefits are covered by your specific plan and what co-payment or responsibility you may have for services rendered, you should call your insurance company prior to your appointment. If you have an insurance plan with which Dr. Mersol-Barg participates, you must bring your insurance card (or a copy, front and back) to your first visit. If we do not have all of the information provided on your card, we may not be able to file or follow-up on an insurance claim, and you will be responsible for the charges. We will also require your policy and group numbers in advance of your appointment so that we can verify your coverage. You can either provide this information via phone, fax or on the initial questionnaire mentioned below. If you have questions about insurance issues, please call.

Under some insurance policies such as HMO and Point of Service plans, you will need a referral from your primary care physician or gynecologist before your appointment. If your insurance company requires a referral, it must be obtained prior to your visit with us. If you don’t have a referral authorizing the services you receive, you will be responsible for the entire bill, which will be due at the time of service. If you are able to obtain a referral after your visit, we will gladly submit a claim to your insurance; once the claim is paid, you will receive a refund.

Initial History Questionnaire and Insurance Information

Please review and fill out the initial history questionnaire. You should mail or fax the completed questionnaire to the Center so that it arrives at least three working days prior to your appointment. Please print or type. When you arrive for your appointment, you will also fill out an insurance information sheet. Please bring your insurance card and driver’s license with you so that copies can be made for our records. These copies are necessary so that we can submit claims to your insurance company. Your insurance company should then make payments to our Center on your behalf; however, if there is any question from the company regarding its responsibility for paying your claim, we will be able to show proof of your coverage and identity in the form of your card and license. Without such proof, we will be unable to submit or justify a claim on your behalf and you will be responsible for all charges associated with your visit.