Patient Information Center
Learn more about our policies and procedures
New Patient Forms
Print the new patient forms below and bring them to your initial appointment!
New Patient FAQs
Answers to your most important questions and new patient forms to fill out
How much will my copayment be?
You will be responsible for the full amount of services provided. However, after your appointment you will be provided with a Superbill which can be used to submit to your insurance provider for possible reimbursement.
Patient Financial Policy and Agreement
We do not accept insurance at this time. Your will be provided will a Superbill to submit to your insurance company for reimbursement purposes. Learn more about our financial policy and sign your agreement form here.
Informed Consent for Ketamine Infusion Therapy
Ketamine Infusion Therapy is an alternative treatment method for patients who struggle with derpession and have been treated unsuccessfully by traditional means. Learn more about Ketamine Infusion Therapy and sign your informed consent forms here.
What is your Privacy Policy?
Your privacy is our priority. To learn more about your rights as a patient and to review our privacy policy click here.
Insurance Information
Learn how your benefits apply
Using Insurance Benefits
Unfortunately, most private and Federal insurance plans do not cover all of the cost of our treatments yet. However, if you have out of network benefits, we recommend contacting your insurance carrier and discussing the possibility of coverage for Ketamine treatments. We can provide you with the billing codes we use during your free consultation so that you can ask your insurance carrier prior to infusions whether they will reimburse any part of your ketamine therapy.
Superbills: We send our patients superbills after each treatment, upon request, that they can submit to insurance independently, or through CharmEHR. Superbills include billing codes and diagnosis codes that are widely accepted by many insurances, including, but not limited to: BlueCross BlueShield, United, Cigna, Carefirst, etc. You can also use your Health Savings Account (HSA) for ketamine treatments at Upstate ketamine and Wellness Center.
Reimbursify: We recommend using Reimbursify to submit your claims, a service paid for by the clinic so that you can maximize on the amount reimbursed via your insurance company. It is very easy to do, simply use the button below to initiate the claim. You will only need to add your insurance information once, and then submit your superbills each time you visit us.
Many of our patients have reported getting 20-80% back from their insurance.
Government Resources
A Health Savings Account (HSA) allows you to set aside funds on a pre-tax basis to pay for qualified medical expenses. By using untaxed dollars in a Health Savings Account to pay for deductibles, copayments, coinsurance, and some other expenses, you may be able to lower your overall healthcare costs. Your treatments at Upstate Ketamine and Wellness Center can be paid for by using your HSA.
A Flexible Spending Account (FSA) is an arrangement through your employer that permits you the option to pay for
many out-of-pocket medical expenses with tax-free dollars. Allowed expenses include insurance copayments and
deductibles, qualified prescription drugs, insulin, and medical devices. Your treatments at Upstate Ketamine and Wellness Center can be paid for by using your FSA.
Financial Assistance Option
Apply for credit: Upstate Ketamine and Wellness Center works with CareCredit to provide a credit option. The application only takes a few minutes, and you'll receive an immediate approval decision in most cases.