We participate with most insurances, please call our office for more information.
List of insurances we participate in:
- Anthem Health
- All Locals (EXAMPLE) Local 338, 707 32BJ ETC.
- Beech Street
- Blue Cross Blue Shield
- Cigna Health Plan
- Empire HealthChoice (AKA BCBS)
- Fidelis Care of NY
- First Health
- Health Net
- Health Source
- HealthCare Partners
- Island Group ADM.
- National Health Plan
- LOCAL 1199
- Magna Care
- The Empire Plan
- One Health Plan
- Railroad Medicare
- Suffolk Health Plan
- United Health Care
- Workers Comp (ALL INSURANCE CARRIERS)
- No Fault (ALL INSURANCE CARRIERS)
Please do not hesitate to contact us if you have any questions regarding participation.
To save time on the day of your appointment, please fill out these forms and bring them with you:
- New Patient Forms (English)
- New Patient Forms (Spanish)
- New Patient Epilepsy Forms (English)
- New Patient Epilepsy Forms (Spanish)
- Follow-Up Patient Forms (English)
- Follow-Up Patient Forms (Spanish)
- Follow-Up Epilepsy Forms (English)
- Follow-Up Epilepsy Forms (Spanish)
Please note: These documents are in Adobe® PDF format. They require Adobe Reader to be viewed. If you do not have Adobe Reader, you can download it for free by clicking here.
Medical Records Report
You can request a copy of your health information by completing a Medical Records Request and Authorization for Disclosure of Health Information Forms and submitting them to South Shore Neurologic Associates, PC. You can submit this form to the appropriate representative by mail, fax or in person.
South Shore Neurologic Associates, PC
Attn: Medical Records Department
77 Medford Avenue
Patchogue, NY 11772
Phone: 631-758-1910 ext. 2120
If you are submitting your request in person, you may do so from 8:30 a.m. to 4 p.m. at our Patchogue Office.
PLEASE ALLOW A MINIMUM OF 7-10 BUSINESS DAYS FOR FORMS TO BE PROCESSED AND A MINIMUM OF 14 BUSINESS DAYS FOR REQUESTS FOR RECORDS
The Medical Records Department of South Shore Neurologic Associates, PC handles all Disability Forms, Physicians' Statements, and other paperwork, which you request your doctor to complete. Your physician will review not only each form but also your medical records before completing the required information.
Please complete the patient information section entirely and provide any pertinent information to avoid processing delays.
The fee schedule for forms is as follows:
- One Page Form $10.00-$15.00
- Two Page Form $30.00
- Three Page Form $50.00
- Four Page Form $100.00-$175.00
- FMLA/Attending Physician Statement $25.00
PAYMENT MUST BE MADE PRIOR TO THE RELEASE OF RECORDS OR FORMS