Fees & Insurance

Upper East Side Psychology takes the stress out of submitting insurance claims by provides courtesy insurance claim submission.

Insurance

We are not in-network with any insurance carriers, but we will submit claims on your behalf or provide you with super bills to submit to your insurance to help you get reimbursed using your out of network benefits. Prior to starting treatment we can contact your insurance company to obtain an estimate of costs based on your benefits and out of network coverage, which we will share with you in order for you to have an estimate of costs associated with your treatment.

Insurance Verification Form

Questions? Contact Us

Fees

We have a range of fees associated with our services. Please inquire to learn more about the cost of the treatment you are interested in.

Insurance Verification Form

Please fill out the form below and we will get back to you with an estimation of your out network benefits.

Patient Info:

First Name

Last name

Phone

Date of Birth

Insurance Info:

Primary Policy Holder (If you are not the primary member)

First Name (Policy Holder)

Last Name (Policy Holder)

Street Address

Address Line 2

City

State

Zip Code

Primary Policy Holder's Date of Birth

Front of Insurance Card

Upload File

Back of Insurance Card

Upload File

Message

Confidentiality Notice: Please note that this form is not a secure medium, and the confidentiality of e-mail cannot be guaranteed. It is recommended that you consider this when communicating about matters that are of a personal or confidential nature.

Thanks! We'll be in touch soon.

Insurance Form

Fees & Insurance

Upper East Side Psychology takes the stress out of submitting insurance claims by provides courtesy insurance claim submission.

Insurance

Fees

Insurance Verification Form

Patient Info:

Insurance Info:

Primary Policy Holder (If you are not the primary member)

Links

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