Patient Forms, Map and Directions to Liberty Endoscopy Center
If you're planning your first visit to Liberty Endoscopy Center, LLC, we look forward to meeting you. To help prepare you, you'll find all the information you need about our practice on this page, including:
- Patient Forms (complete this prior to your appointment to save some time)
- Insurance and Billing information
- Directions and maps
Download our forms (PDF format):
- Notice of Privacy Practices ENGLISH
- Notice of Privacy Practices SPANISH
- Patient Rights & Responsibilities ENGLISH
- Patient Rights & Responsibilities SPANISH
- Assignment of Benefits - Authorizations & Disclosures ENGLISH
- Assignment of Benefits - Authorizations & Disclosures SPANISH
- Anesthesia Consent ENGLISH
- Anesthesia Consent SPANISH
- Procedure Consent ENGLISH
- Procedure Consent SPANISH
In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.
Insurance and Billing
In-network Insurances accepted:
- Blue Cross Blue Shield BCBS
- United HealthCare UHC
Please contact our office to verify acceptance of your insurance plan. Qualifications for insurance coverage may differ due to the uniqueness of each procedure.
About Your Bill
Liberty Endoscopy Center will make every effort to keep this process as simple as possible. Your procedure will generate several different bills from different sources
- Liberty Endoscopy Center's bill covers the use of the facility and all necessary supplies used during your procedure. Liberty Endoscopy Center will also be submitting a claim for anesthesia services provided.
- You will receive a separate bill from your physician.
- Laboratory/Pathology services that may be used for your procedure will be billed separately.
Our facility works with your doctor's office to make sure we have accurate insurance information. As a courtesy, we will contact your insurance carrier if there is any question about your eligibility. We will make every attempt to notify you of your financial responsibility ahead of the time of service. If you cannot be reached you will be given the amount at check-in.
Please call (646) 215-2244 for payment plan options.
For billing information or questions about your bill, please call (212) 874-3384 ext 518.
Pledge to Charity
Liberty Endoscopy Center recognizes that many individuals in our community require medically necessary services, but may not have adequate financial resources to pay for these services. Liberty Endoscopy Center has an established policy for extending charity care services to patients that do not have the ability to pay.
To make an appointment, please contact our Administrator at (646) 215-2244
What To Expect
Being well-prepared for your appointment will ensure that the doctor has all of the needed information to provide the best possible care for you. It will also help alleviate any unnecessary anxiety you may be feeling prior to your first appointment. Educate yourself on your symptoms by reviewing the content on this website. Also, take some time to review our staff page and familiarize yourself with the doctors. We look forward to your first visit.