Insurance Coverage Verification

Download a printable version of the form here

Every insurance plan provides a different level of coverage and also different co-pays. In order to receive the best information regarding this question, you should contact your insurance company and ask them if your plan covers, at Cayuga Center at Cayuga Medical Center, a visit to a specialist "provider" for your diagnosis, whether that is hypertension or diabetes, for example. We recommend that you get the name and the department of the person with whom you spoke, for further reference. You can also check with your employer's human resources to determine the exact benefit levels of your employer-sponsored plan. If your plan requires pre-authorization you must check with your primary care physician to make sure that the authorization was made prior to beginning treatment.

Cayuga Center for Healthy Living offers a wide range of classes and services. Our services are billed as a visit to a dietitian or billed as a specialist provider visit, as mentioned above. It is worth asking your insurance company if you should submit a claim for reimbursement or if you could use your FLEX spending account. Our billing policy for some of our classes is as follows:

For all these self-pay classes the entire amount of the class is due prior to attending class. If you think insurance will cover it you are responsible for submitting the claim. The class fee is non-refundable if you do not attend any or all the classes.

Cancellation, No-Show, and Late Policy
We understand that unforeseen circumstances sometimes arise making it impossible for patients to keep appointments. When a patient fails to show up, and does not call or cancel, someone else is deprived of the chance to receive care. We therefore ask that you please call us 24 hours in advance when you are unable to keep your scheduled appointment. If you are chronically late (2 visits), fail to show up for scheduled appointments (2 visits), or cancel repeatedly (4 visits), we reserve the right to discharge you from CCHL services. We'll also contact your PCP to let them know you have been discharged. We appreciate your cooperation and look forward to working with you.

Patient Responsibilities:
I will call my insurance company to check my Insurance Coverage for Cayuga Center for Healthy Living Services. I understand the statements above and I am the patient or am duly authorized by the patient, as the patient's general agent, to provide acknowledgement.

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