Patient Financial Policy
Thank you for choosing Premier Dermatology Clinic, LLC as your healthcare provider. We are committed to your treatment being a positive experience. Please help us maintain accurate records by filling out forms legibly and inform us if any changes need to be updated on your account.
Insurance and Insurance Collection
Please have your insurance card available at the time of service. If you are unable to present an insurance card, or if you are covered by an insurance company with which we are not contracted, we require that you pay for services at the time of service. If we are able to collect payment from your insurance company after you have fully paid your account, we will issue you a refund. We will gladly bill your insurance company, if contracted, as a courtesy. Any balances that your insurance company has not reimbursed or acted upon within ninety (90) days will be transferred to your responsibility. If you wish to dispute a charge, you will have 30 days after our first billing statement is received. After this time period, all charges are considered final and no further modifications will be allowed.
Know Your Plan Benefits – Non-Covered Services Are Your Responsibility
Each insurance company, including Medicare, has different plans, each with different benefits. Your health insurance is an arrangement between you and your insurer, therefore you should understand what services are covered under your specific plan. Please contact your insurance carrier who can assist you with any questions you have related to your own benefits and coverage. All co-payments, co-insurance, and/or deductibles are your responsibility. Co-payments are due at the time of service with no exceptions. This is a requirement of your insurer and our office policy. Federal and State insurance regulations prohibit us from discounting or waiving your assigned co-pay or deductible.
We may decline to see patients for non-emergent visits if co-payments are not made at the time of the visit. In addition, please be aware that Dr. Robert Lee may provide services that may not be covered as a benefit under your specific insurance plan. Your insurance carrier may disallow certain diagnoses or services as medically uncovered, medically unnecessary, or cosmetic. The criteria for medical necessity are at the discretion of the insurance carrier and can change at any time. Patients or Guarantors are financially responsible for any and all services provided that may not be covered by your insurance plan. It is your responsibility to know and understand your specific insurance plan and what benefits are provided.
Some procedures you may undergo at our office will involve removing skin or tissue to be examined under a microscope to determine a diagnosis. The charges for this service are known as Laboratory or Pathology charges and will appear on your bill if performed. There are two separate charges for this service. The physician who looks at the slide and provides his/her interpretation based on those slides is known as the Pathologist. There is a charge for that physician’s professional opinion, which is separate from the charge for preparing the actual slide to be examined. Premier Dermatology Clinic, LLC reserves the right to send specimens to an outside laboratory for special staining purposes, pathologic interpretation, and/or to obtain a second opinion. Premier Dermatology Clinic, LLC is not responsible for any outside facility charges that may be incurred. If you have questions about these lab fees, please contact the lab directly as these fees are not charged by our office.
Patients with HMO plans who are referred by another provider are responsible for obtaining and bringing proper written authorization prior to their visit. It is your responsibility to verify that they properly authorize your visit and treatment in advance. If no authorization is present, a patient can be seen on a cash basis, but will not be reimbursed for the charges.
Having more than one insurance does NOT necessarily mean that your services are 100% covered. Depending on your specific plan’s benefits, the secondary insurers will pay as a function of what your primary insurer pays. We will bill your secondary insurer as a courtesy. You are responsible for any balances after your insurers have processed our claims.
You are responsible for your annual deductible and 20% of the allowable fee for covered services. We will bill any secondary or tertiary insurance you may have once we have been informed that you have such coverage. If any balance remains after your claims have been processed, we will transfer responsibility to you and send you a statement.
Important reminder for Medicare enrollees: If you qualified for Medicare coverage and decided to enroll in a Medicare+Choice/Medicare Advantage plan, you may need to obtain a referral from your Primary Care Physician (PCP) before your visit with Premier Dermatology Clinic, LLC will be covered. Please call the phone number on your insurance card for information on your specific plan.
The adult accompanying a minor and the minor’s parents or guardians are responsible for full payment for services rendered. If a minor is unaccompanied, consent for treatment and payment arrangements must be provided in advance.
Return Check Fee
There is a $25.00 banking fee imposed for returned checks. This sum is used to offset the fees incurred by Premier Dermatology Clinic, LLC by our bank. Payments must be made within 10 days to avoid collection's actions. Future payments must be made with cash, money order, or credit card.
Premier Dermatology Clinic, LLC will send you a statement after your insurers have been billed and your insurers have considered your charges. If no payment is received after 120 days, your account may be turned over to a collections agency. A $25.00 late payment/pre-collection fee will be added to your account to offset the administrative costs incurred when accounts are assigned for collection.
Request for Medical Records
A signed release of records form is required at the time of your request. You will be charged $0.25 cents per page copied, plus clerical fees of $25.00. If you request the records to be mailed to you, please note that postage fees are not included, and will be charged separately. The medical records will not be released to you until our fees are paid in full.