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FAQs: Health Insurance Billing and Fees at Sexual Health Clinics

The New York City Health Department asks for a fee for Sexual Health Clinic services given to adults (age 19 and over). The Health Department must ask for insurance or payment for services to meet Medicaid standards and other legal requirements.

  • If you want to use your health insurance to pay for the visit, your insurance plan will be billed. A copayment may be required.
  • If you do not have health insurance or do not want your insurance billed for the visit, you will be asked to pay a sliding scale fee based on your family size and yearly income. You will not be asked for proof of family size or yearly income. No payments will be collected at the clinic.

If you do not have insurance or cannot pay the fee, you can still get services.

I am under 19 years old. Do I have to pay for the visit?

No. If you are under 19, you will not be asked for insurance information or payment for the visit.

Is my visit confidential?

Yes. Please ask clinic staff for the Health Insurance Portability and Accountability Act (HIPAA) Notice of Privacy for details. The Health Department will not send you any bills, financial statements or receipts.

Please note: Many health insurance providers send an Explanation of Benefits (EOB) to the policy holder with details of the visit (including tests, diagnoses and treatment). If you are concerned about information being sent to the policy holder, you can contact your insurance provider and ask for the EOB to be sent to another address. Another option is to pay for the visit yourself using the Health Department’s sliding scale.

What if I do not have insurance or do not want my insurance billed for the visit?

You can still receive services. The Health Department will ask you to pay a sliding scale fee based on your family size and yearly income. You will not be asked for proof of family size or yearly income. No payments will be collected at the clinic. You can mail payment after your clinic visit.

How do I pay the sliding scale fee?

No payments will be collected at the clinic. Instead, please complete a check or money order (not cash) payable to NYC Department of Health and Mental Hygiene. Please mail the check or money order to:

NYC Department of Health and Mental Hygiene
Attn: Division of Finance
42-09 28th Street, CN32W
Long Island City, NY 11101

The check or money order should include the patient’s name, date of visit and patient’s ID number. Clinic staff will provide this information at the visit.

The Health Department will not send you any bills, financial statements or receipts.

Can I use health insurance to pay for the visit?

Yes, you can choose to use your insurance. The Health Department will bill your insurance for sexually transmitted infection (STI) services. Please note: You or the policy holder may receive an Explanation of Benefits (EOB) from your insurance provider. The EOB will list the services you received and show if you owe a copayment.

If you are concerned about the EOB being sent to the policy holder, you can contact your health insurance provider and ask for it to be sent to another address, or you can choose to pay for the visit yourself using the sliding scale.

What if I did not bring my insurance card with me today?

The Health Department will give you a letter so that you can mail your insurance information after your visit.

I am covered under someone else’s health insurance plan. Will the Health Department bill that person’s insurance?

Yes. Please note: Many health insurance providers send an Explanation of Benefits (EOB) to the policy holder with details of the visit. The EOB will also show if a copayment is owed.

If you are concerned about the EOB being sent to the policy holder, you can contact your health insurance provider and ask for it to be sent to another address, or you can choose to pay for the visit yourself using the sliding scale.

What if I owe a copayment?

If the Explanation of Benefits (EOB) shows that you owe a copayment, please mail a check or money order (not cash) payable to NYC Department of Health and Mental Hygiene to the address listed below. The check or money order should include the patient’s name, date of visit and patient’s ID number. Clinic staff will provide this information at your visit. This will be printed on a label during registration at the clinic.

NYC Department of Health and Mental Hygiene
Attn: Division of Finance
42-09 28th Street, CN 32W
Long Island City, NY 11101

Will the Health Department send anything to my home, such as a bill, financial statement or receipt?

No. The Health Department will not send you any bills, financial statements or receipts.

Please note: Many health insurance providers send an Explanation of Benefits (EOB) to the policy holder with details of the visit. The EOB will also show if a copayment is owed.

If you are concerned about the EOB being sent to the policy holder, you can contact your health insurance provider and ask for it to be sent to another address, or you can choose to pay for the visit yourself using the sliding scale.

Will the clinic keep my insurance information even after the bill is paid?

Yes, but at each visit, you can choose to use your insurance or pay the sliding scale fee. If your insurance has changed since your last visit, please tell clinic staff.

When my health insurance is billed, what information does the Health Department send with the bill?

The information on the bill includes the patient’s name, address, date of birth, insurance ID, services given, service date and amount charged. The provider listed will be “NYC Department of Health and Mental Hygiene,” plus the clinic location (for example, “Fort Greene Health Center”).

My health insurance only covers in-network providers. Is the clinic an in-network provider for my insurance plan?

The clinic is in-network for some insurance plans. Even if your health insurance provider says the claim is out-of-network and denies it, you will not be held responsible for payment.

If my health insurance provider sends me a check for this visit, what should I do?

Please sign the back of the check and write “Payable to NYC Department of Health and Mental Hygiene only” under your signature. Make a copy for your records. Submit this signed check along with your Explanation of Benefits (EOB) to:

NYC Department of Health and Mental Hygiene
Attn: Division of Finance
42-09 28th Street, CN 32W
Long Island City, NY 11101

Will this service be deducted from my yearly Medicaid allowance?

It may, depending on the services received. However, your primary health care provider will be notified during the eligibility process and can submit a Threshold Override Application (TOA), to increase the amount of services allowed.

Where can I find out if I am eligible for Medicaid or get health insurance coverage?

Some clinics have on-site enrollment counselors who can check if you qualify for public health insurance coverage (such as Medicaid or Medicare) and help you sign up. If you do not qualify for public health insurance coverage, you can apply for health insurance through the New York State Benefit Exchange website or by calling 311.

Do I need a referral from my primary care provider to receive services at this clinic?

No. You do not need a referral to receive services at any Health Department clinic.