Administrative Information

Click here for additional Covid-19 information, including what to do prior to your appointment, safe quarantine, and vaccinations.
Click to jump to Office Forms section below.

Insurance and Payment Information

Cancellation or change policy


You must give 48 hours notice if you cannot keep your in-person appointment (24 hours for a telemedicine appointment) or a $50 fee will apply.


Insurance plans

Dr. Weiss accepts:

  • Cigna (in-network):
    Actors’ Equity and all other plans except ‘Exchange’ plans.
  • SAG/AFTRA Health Plan (out-of-network):
    We will accept the insurance.  Most charges are covered.  Please call for further information.
  • United Healthcare (in-network):
    All plans except ‘Oxford,’ ‘The Empire Plan,’ ‘Exchange’ plans.
    If your United Healthcare card has ‘Oxford’ under the logo or ‘The Empire Plan’ on the front, then Dr. Weiss is out-of-network.
  • Workers’ Compensation, New York State:
    Professional performers and theatre staff only.
    A copy of the “C-2” form (accident or injury report), completed by your employer, is required prior to your visit.
    • NOTE:
      We work with all insurance carriers, but a few are extremely difficult to deal with.  These carriers seem to design their operations to obstruct proper medical care.  Unfortunately, we don't have a large staff who can spend the time that would be needed to battle these carriers.  Therefore, we only accept new cases from the following carriers on an individual basis:
      The Hartford
  • Workers’ Compensation, other states:
    Professional performers and theatre staff only.
    Workers’ Comp cases from states other than New York are only accepted on an individual basis. 

Dr. Weiss does NOT accept:

  • Medicare
  • Medicaid
  • Exchange Plans
  • No-Fault (motor vehicle accident insurance)
  • Any other insurance

If you have these insurances, you can see Dr. Weiss in consultation, but payment is required at the time of service.
For all plans where Dr. Weiss is “out-of-network” and for no-fault, we will give you a claim form that you can submit to your insurance company so that you can obtain reimbursement.

IMPORTANT:  Medicare patients cannot receive any reimbursement from Medicare or any other insurance plan, as Dr. Weiss has ‘opted out’ of Medicare.

Supplies

For braces and splints, please be advised that even if we bill your insurance, the costs of braces and splints are your responsibility.  These charges may be subject to a separate co-payment or a separate deductible, according to the specifics of your insurance policy.

Payment options

For payment we accept:

  • Check
  • Debit Cards
  • Credit Cards (Mastercard, Visa, American Express, Discover)

Office Forms

PDF Medical Records Authorization
This form can be used to request that Dr. Weiss (1) send your medical records to another physician or to any other person that you authorize, or (2) request your medical records from another physician or healthcare facility.

PDF Patient Demographics Form
Complete this demographics form before you visit for your consultation.  Please follow the instructions in the email that we send you. 
Download and save the form.  Open either (1) on your mobile device using the Adobe Fill & Sign app (free download for Apple devices or Android devices) or (2) on your computer using Adobe Reader (free download).  Save the completed form on your device; then email it to our office before your visit.

PDF Patient Medical History Form
Complete this medical history form before you visit for your consultation.  Please follow the instructions in the email that we send you. 
Download and save the form.  Open either (1) on your mobile device using the Adobe Fill & Sign app (free download for Apple devices or Android devices) or (2) on your computer using Adobe Reader (free download).  Save the completed form on your device; then email it to our office before your visit.

PDF Map of NYU Langone Health, Manhattan Campus
Map of the main campus of NYU Langone Health, including the Emergency Room entrance and Faculty Practice Radiology (Green Pathway).

PDF Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information.