COVID-19 PCR Testing with APP Health Group

COVID-19 PCR Testing with APP Health Group

-----Please fill out one form for each person being tested----
APP Health Group has partnered with Ben L of Accu Reference Medical Lab for easy, fast, and reliable drop-in COVID-19 PCR Testing in Riverdale and New Rochelle. No out of pocket charges for insured patients. To avoid long wait times we ask you to choose an approximate time to come in so we are staffed for "quality speedy testing". Choose the office location and the date you need your test done. No one will be turned away for being early or late. Our turn around time for results is 24 hours or faster. Always check with staff on-site for most recent turnaround times. Be sure to check your confirmation email for how to access results!**** Note: Results have been consistent the last few weeks. This form will be updated if turnaround times change.
Uninsured Payment Note $100 - New starting March 23, 2022

As of 3/23/2022 the government is unfortunately no longer funding the HRSA program that covered uninsured patient COVID-19 testing. The out of pocket cost for uninsured patients is $100 and will be charged at time of visit. We hope the government will change their mind and fund this program once again. Until that time this is our only option for uninsured patients and reflects a negotiated discounted rate. Reminder that we accept all insurances and there is still no cost associated with insured patients. Any updates will be posted here.
RIVERDALE- THIS LOCATION RELOCATED

PREVIOUS LOCATION: 6 Ploughmans Bush, Bronx, NY 10471 NEW LOCATION: 5600 RIVERDALE AVE, Bronx, NY 10471
NEW ROCHELLE

175 Memorial Highway, Suite LL-7, New Rochelle, NY 10801
NEW LOCATION EFFECTIVE OCTOBER 23RD RIVERDALE

5600 RIVERDALE AVE
Testing Location*

RIVERDALE - ***NEW LOCATION*** 5600 Riverdale Ave, Bronx, NY 10471NEW ROCHELLE - 175 Memorial Highway, Suite LL-7, New Rochelle, NY, 10801 (Mondays-Thursdays)
Day and Time to come to our NEW 5600 RIVERDALE AVE Office*
Day and Time to come to our New Rochelle Office*
I am aware that the Riverdale clinic moved to 5600 Riverdale Ave, Bronx, NY 10471*

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Name (Please make sure it's in correct order) *

**FIRST NAME****LAST NAME**
Date of Birth*

MonthDayYear
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MF
Phone Number*
Email*
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Address (US)*

Street Address

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CityState

Zip Code (5 Digits)
Do you have medical insurance?*

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$100 Charge: I am uninsured and agree to pay $100 for the COVID-19 PCR test at time of visit. (Test will not be performed without payment)*

I agree
Primary Insurance*
Insurance Company Name (If uninsured write uninsured in box)
Unfortunately, we are unable to accept Healthfirst as a primary insurance at this time. However, we can still administer a PCR test for the uninsured rate of $100/test. You can then submit for reimbursement from Healthfirst if you choose.*

I agree to pay $100 for the COVID-19 PCR test at time of visit. (Test will not be performed without payment)I do not agree to pay $100 for the COVID-19 PCR test
Policy Number*
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(If known)
Insurance Card Picture*

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PLEASE READ CAREFULLY: Results are typically available by end of next day (See above for all updates). There are no co-pays or costs to you. You agree to assign insurance payment for this testing to APP Health Group. If your insurance sends payment for this testing directly to you, you agree to send that payment amount to APP Health Group at 6 Ploughmans Bush, Bronx, NY 10471, in a timely manner. If you have further questions you can email support@apphealthgroup.com. Any questions about results can be directed to Accureference (908-474-1004). By signing below, you consent to have you and/or your child tested by APP Health Group and Accur Reference Medical Lab. You also agree to have results emailed to you.

Receiving Results: If it has been more than 36 hours after you have tested and you would like to check on status of your results: For faster service you can check your results on the Accureference Patient Portal. Go to https://results.accureference.com/patientportal/index.html

Then click on View My Results --> Then "Click here if you do not have an access code" -->Enter your name, date of birth, and your email OR phone number you used to register. It should then send you a Access Code. If it still does not you can email support@apphealthgroup.com or call Accureference Line at 908-474-1004. If above does not work and it has been 48 hours since you tested, you can come back to your testing location in person to receive results.

Uninsured Payment Notice: Uninsured patients will be responsible for a $100 charge for services rendered at time of appointment. This fee covers the testing and you will not be responsible for any additional payments.
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COVID-19 PCR Testing with APP Health Group

Uninsured Payment Note $100 - New starting March 23, 2022

RIVERDALE- THIS LOCATION RELOCATED

NEW ROCHELLE

NEW LOCATION EFFECTIVE OCTOBER 23RD RIVERDALE