Thank you for selecting Advanced Dermatology, P.C. for your dermatological cares. In order to prevent any misunderstanding concerning the responsibility regarding payment for medical/ surgical and/or any laboratory fees, the following is provided.
HMO/PPO/Other Insurance Coverage: If you have insurance through a company we have contracted with, we will require a copy of your insurance card and a driver’s license. All co-payments are due prior to seeing the physician. If your insurance carrier requires a referral from your primary care physician, this must be present at the time of service. Failure to provide all necessary information may require you to pay in full on the date of the visit. It is your responsibility to keep track of the referral expiration dates and the number of visits given by your primary care physician. You will be responsible for any services denied by your insurance carrier as not medically necessary and/or not covered. If you have coverage with an insurance carrier with which we do not participate (“out of network”), payment is due at the time of service. We will provide you with a receipt that you can submit to your carrier for reimbursement, if applicable.
Medicare: Our physicians are participating Medicare providers and accept Medicare assignment, which is the ALLOWABLE charge approved by Medicare. Medicare will pay 80% of the allowable charges after you pay for your annual deductible. You are responsible for any amounts applied to your deductible and the 20% co-insurance. If you have a secondary insurance, as a courtesy we will submit to that particular carrier any remaining balance. You will also be responsible for any services denied by your insurance carrier as not medically necessary and/or not covered.
Laboratory: Depending on your insurance carrier’s policy, you may be required to pay a separate co-payment for any specimen taken during your visit.
Self-Pay Patients (Will Pay): Patients with no insurance, the guarantor is responsible for the bill at the time of service.
Cosmetic Patients: Deposits are required prior to the date of the procedure. The balance of the payment is required prior to the procedure being performed.
Payments: We utilize a guaranteed check service, which automatically deducts the amount of your check from your account immediately. This is similar to how your credit or debit card works by showing us if funds are available in your account.
Refund Policy: We do not offer refunds on medical and cosmetic procedures.
Cancellation Policy: A charge will be made for broken appointments unless 24 hours notice is given.
Returned Checks & Collections: A charge of $25 will be made for all returned checks. In the event that any action is brought to collection, you agree to pay any reasonable collection costs and/or attorney fees.
No Show Policy: In an effort to maximize time your physician spends with you and minimize your wait time, we have made changes to our No-Show Policies as follows.
Effective immediately, a No-Show Policy which will affect all patients who do not keep their scheduled appointment or who cancel an appointment with less than a 24-hour notice.
- Patient will receive a letter and a $25.00 no-show fee assessment for dermatology office visits.
- Patient will receive a letter and a $100.00 no-show fee assessment for surgical visits.