Kathy Levine MS, RD, CDN
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Insurance Form

While I am pleased to submit insurance claims as a courtesy to my patients, please note that you as the patient are responsible for payment should insurance fail to cover the visit for any reason. To avoid unpleasant surprises, please call your insurance company to obtain answers to all the questions below.

    Patient Information


    Primary Insurance

    Spouse, self, parent, etc.
    Max file size: 20MB
    Please take a photo of the front of your insurance card and upload it here. You may also email the photo to rdklevine@gmail.com.
    Max file size: 20MB
    Please take a photo of the back of your insurance card and upload it here. You may also email the photo to rdklevine@gmail.com.

    Secondary Insurance

    Note that secondary insurance does not include supplemental policies such as AARP.
    Spouse, self, parent, etc.

    Information to be Obtained from Insurance Company

    Please call your insurance company to answer the questions below. Please ask for a reference number for your call and enter the number in the form below for future reference.
    ​

    ​The following information may be helpful for your call:
    • My provider ID# is 1134161300
    • You will need a procedure code as well as a diagnosis code that your insurance covers 
    • The procedure codes I use are 97802 and 97803
    • ​Many plans cover the diagnosis code: Z71.3   Contact me if you need help finding a covered diagnosis code.
    This is an extra that allows me to measure your energy expenditure, but is not required for our visits.
Submit

Goldens Bridge Office Building
​100 North County Shopping Center
Suite 203
PO Box 223
Goldens Bridge, NY 10526   

 Phone: (914) 767-0734
Fax: (914) 232-8537
rdklevine@gmail.com