In order to provide the best care and avoid any last-minute cancellations, we require a medical history questionnaire to be completed. This is available online for your convenience and must be completed at least 24 to 48 hours prior to your scheduled surgical date.
- Please complete all sections
- If a section does not apply, please select the check box for “No Issues”
- Be sure to include your complete medical history including current conditions, prescription and over-the-counter medications (past and present), past medical conditions/surgeries
Upon receipt, someone from our team will call you regarding your appointment.
One of our insurance verification specialists will contact you if there is an anticipated out-of-pocket expense associated with your planned procedure. Please realize charges for your procedure at The Center for Advanced Spine & Joint Surgery are separate from your surgeon’s charge as well as any anesthesiologist* and/or pathologist charges which may be incurred.
If your procedure is not covered by insurance, full payment is required at the time of service unless other arrangements are made in advance.
Patients – or their legal guardians – are ultimately responsible for payment of facility services at The Center for Advanced Spine & Joint Surgery. As a courtesy, The Center for Advanced Spine & Joint Surgery will bill your primary and secondary insurance carriers for you. Please bring your insurance cards with you on the day of surgery. We are required to collect all co-payments from our patients and we will call you to discuss any patient responsibility related to your co-payments. Such co-payments may include deductibles, co-insurance, or any non-covered items identified by your insurance plan.
The Center for Advanced Spine & Joint Surgery accepts cash, checks, any major credit card, a Flexible Spending Account (FSA), or a Health Savings Account (HSA) as a financing option. Feel free to contact our business office at 934-223-4500 Monday through Friday 8:30 AM to 4:00 PM with questions regarding your billing or insurance information. We will be happy to assist you.
*Anesthesia services at The Center for Advanced Spine & Joint Surgery is provided by Long Island Anesthesia Physicians. Questions concerning their fees should be directed to their billing service at 1-866-787-4426 ext. 115 or visit https://lianesthesia.com/.