What to Bring to Your Appointment:

    * Your insurance card and a picture ID
    * Physicians referral forms if required by insurance
    * Pertinent information about your medical and surgical history
    * Any recent x-rays or appropriate records you may have
    * A list of current prescription, over-the-counter, or herbal medications
    you are taking, including dose and frequency

Patient Forms/ Questionnaire Mailings:

New patients will need to fill out information about their health history and their registration / payment information.
Follow-up patients often need to fill out questionnaires filled out depending on
the condition being treated.
Please print these forms and fill them out prior to your appointment:

Hospital Affiliations:

Dr. Sergey Rome and Dr. Steve Lebovitch - Hackensack University Medical Center, The Valley Hospital
Dr. Richard Campo The Valley Hospital Dr. Sadeghi-Nejad - Hackensack University Medical Center, UMDNJ - New Jersey Medical School, Veterans Administration at East Orange, NJ


Insurance, Payment, Billing Information:

Physicians at the Urological Institute accept Medicare and most insurance plans. Unfortunately, Medicaid without Medicare is not accepted.

We provide insurance billing for insurance plans we accept. Anything not covered by insurance will be your responsibility.

We request payment at the time of your appointment for services that are not covered by insurance.

Your insurance company may also require you to pay a co-payment at the time of your appointment; you are fully responsible for payment of the co-pay before any services are rendered. If there is a deductible on your insurance policy, you are responsible to make prompt payment if our office is not reimbursed for services rendered.

When necessary, our staff will work closely with patients who require a payment plan.

We accept major credit cards for payment (Visa/MasterCard). We will automatically bill your insurance carrier for you, and each month you will receive a statement outlining the activity on your account if it is active. Our fees are reasonable and are typically near the 50th percentile for the United States. Please address any questions concerning specific fees prior to any procedure or testing that you may undergo. Questions concerning billing, accepted insurances or professional fees should be addressed to our Accounts Manager during office hours. Questions regarding your plan's coverage and benefits should be directed to your employer or insurance company.