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Practitioners
Nicole A. Bell, MD, F.A.C.O.G.
Christine J. Duncan, MD, F.A.C.O.G.
Esther Hirschhorn, MD, F.A.C.O.G.
Marci Ostroff, M.D. F.A.C.O.G.
Marni Jae Sanders, M.D. F.A.C.O.G.
Renata Scott-Ram, MD, F.A.C.O.G.
Nicole R. Smizer, MD, F.A.C.O.G.
Amy Newman, CNM WHNP
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Practice
Our Practice
Insurance Disclaimer
Practitioners
Nicole A. Bell, MD, F.A.C.O.G.
Christine J. Duncan, MD, F.A.C.O.G.
Esther Hirschhorn, MD, F.A.C.O.G.
Marci Ostroff, M.D. F.A.C.O.G.
Marni Jae Sanders, M.D. F.A.C.O.G.
Renata Scott-Ram, MD, F.A.C.O.G.
Nicole R. Smizer, MD, F.A.C.O.G.
Amy Newman, CNM WHNP
Hospital
Media
Services
Office Procedures
Hospital Procedures
Gynecologic Management
Personalized Wellness Consultation
Cosmetic Treatments
Pregnancy
Pregnancy Care
Pregnancy Info
Courses/Services
Testimonials
Contact
Request An Appointment
516-437-4300
Billing Inquiries:
516-673-4706
1 HOLLOW LANE, SUITE 315, LAKE SUCCESS, NY 11042
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Marci Ostroff, MD
Marni Sanders, MD
Christine J. Duncan, MD
Nicole A. Bell, MD
Nicole R. Smizer, MD
Esther Hirschhorn, MD
Amy Newman, NP
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YOU MUST PRESENT A VALID CURRENT INSURANCE CARD & VALID PHOTO ID AT TIME OF APPOINTMENT. YOUR COPAY IS DUE AT CHECK IN.
Assignment of Benefits
Medicare Patients - I request that payment of authorized Medicare benefits be made to WOMEN FOR WOMEN OBSTETRICS AND GYNECOLOGY for any services furnished to me by Marci Ostroff, M.D., Christine Duncan, M.D., Marni Sanders, M.D., Nicole A. Bell, M.D., Nicole R. Smizer M.D., Esther Hirshhorn, M.D., Amy B. Newman, CNM, WHNP. I authorize any holder of medical information about me to release to the Health Care Financing Administration and its agents, any and all information needed to determine benefits or benefits payable for related services. I certify that the information given by me to WOMEN FOR WOMEN OBSTETRICS AND GYNECOLOGY, in applying for payment under the Medicare program, is correct and complete. I authorize the release of all records required to act on this release. This assignment will remain in effect until revoked by me or amended on the HIPAA form provided to me. I understand that I may be held responsible for any balance due for services that Medicare may consider not covered. For services that require specific guidelines from Medicare, an ABN must be provided to me to sign. I understand that interest and collection fees may apply if the account becomes delinquent.
Non-Medicare Patients - I hereby assign to WOMEN FOR WOMEN OBSTETRICS AND GYNECOLOGY any and all benefits from my insurance plan or any other protection maintained by the patient and/or on the Patient's behalf or benefit, and authorize and direct such benefits to be paid directly to WOMEN FOR WOMEN OBSTETRICS AND GYNECOLOGY or Marci Ostroff, M.D., Christine Duncan, M.D., Marni Sanders, M.D., Nicole A. Bell M.D., Nicole R. Smizer M.D., Esther Hirshhorn, M.D., Amy B. Newman, CNM, WHNP. for services provided to the patient by the listed providers. I certify that the information given by me to these providers for payment under any Insurance plan, Managed Care or any other payment protection is correct and complete. I authorize the release of all records required to act on this release. This assignment will remain in effect until revoked by me or amended on the HIPAA form provided to me. I understand that I may be held responsible for any balance due for services that my insurance plan may consider not covered. I understand that interest and collection fees may apply if the account becomes delinquent.
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