Insurance and Billing Information

Please read the following information regarding our insurance and payment policies. If you have any questions, you can reach our billing office at (716) 362-9730 ext. 603, or call your insurance carrier.

Insurance Cards

Please bring all of your current insurance cards to your visit.

Payments Are Due at Time of Service

Co payments, co-insurances, and previous balances are due at the time of your visit. If your child is scheduled to have surgery, any previous balances must be paid prior to the date of surgery.

High Deductible Plans (Health Savings Accounts or Health Reimbursement Accounts)

If your insurance is a high Deductible Plan you will be required to pay a $150.00 deposit prior to your visit.  If the total cost of services rendered is more than $150.00, you will be billed for the remaining amount.

Non-participating Insurance Companies

We participate with most insurance carriers. These are listed in our full financial policy. If we do not participate with your insurance, payment is due at time of service, and we will bill your insurance company as a courtesy.

Rescheduling Appointments:

If you need to reschedule your child’s appointment, we ask that you give us 24 hour notice.  This will allow us to fill that appointment slot with another patient that is waiting to be seen.  If you fail to keep your appointment or if you cancel you appointment with less than 24 hours notice, there will be a $40.00 charge applied to your account.

Billing Statements

We will mail a statement for any balance due once we have received payment or explanation of benefits from your insurance company. Payment is due upon receipt of this statement.

Medical Managed Care and Government Programs

If your child is covered by a Medicaid Managed Care Program or a Child Health Plus program, please make sure you have selected a primary care physician with your insurance. Each of these contracts requires a referral to our providers, because they are specialists. Contact your primary care physician and inform them of your appointment, so they can make a referral to our office.


If you proceed with your physician’s recommendation for surgery, a pre-surgical deposit may be required.  Some insurance plans have a deductible and/or co-insurance.  We will estimate and discuss with you any amounts due prior to surgery, based on your insurance benefits and coverage.  If you decide to cancel surgery less than 24 hours prior to surgery for a non-medical reason, there will be a $100.00 charge applied to your account.

Payment Arrangements

If you are unable to pay your balance upon receipt of our statement, please call our office at 716-362-9730 ext. 603, to make payment arrangements.

Filing out forms

There is a $5.00 fee for any form that needs to be completed by our practice.  This fee must be paid prior to the forms being filled out.  (example: FMLA forms)

Late Fees

Patient balances are due within 30 days from the date of the initial statement.  A $15.00 late fee will be assessed on each patient statement generated after the first statement until the outstanding balance is paid.  Please contact our billing department if you are unable to pay your balance and we can arrange a payment plan.

Complete Version of Financial Policy


Click here to download a PDF of our financial policy.