It is our privilege that you have chosen Dermatology Associates, PC to participate in your healthcare. As a patient in our practice, It is important that you are aware of our financial policies. We encourage you to carefully read this notice in its entirety and please ask one of our staff members if you have any questions.
A patient without insurance coverage is expected to pay at the time of service, we accept cash, checks, and credit cards. Any procedures, medications, etc. are not covered by the office visit cost. This will be an additional cost, if you would like to know the cost before any procedure is done, you may ask that during your visit before any procedure is performed. The amount collected at check in is an AVERAGE cost, your final bill is determined by what is done during your office visit. You may still receive a bill for the difference.
We accept most insurance plans. But it is ultimately up to the patient to know their plan and network with their insurance company. We submit all claims to your insurance company, but if Dr. Johnson is not within your network, you as the patient will be responsible for the full amount of your bill if your insurance company does not cover your visit. The best way to find this information out, is for the patient to directly call their insurance company and ask if Dr. Sonya Campbell Johnson and Dermatology Associates, PC is within your network. (please see end of consent form for more information)
Co-Pays, Co-Insurance, and Deductibles
Your co-pay is due at the time of service (the day of your appointment). After your insurance is filed and your insurance company makes the determination, you will be billed for the balance due. That includes co-insurance left over, deductibles, non-covered charges, and any remaining balance. It is our office policy if you have an unmet deductible, that we will collect $75 at check-in and that amount will go toward what is billed for your visit. This will occur on every visit if your deductible is unmet.
Out of Network Insurance
If your insurance plan is out of network (Dr Johnson is not a participating physician) You will be responsible for any out of network non-covered services, deductibles, and other remaining balances. (see end of consent for more info on this)
These services are NOT covered by insurance. Payment in full is required by the time of service. All monies are non-refundable, however is transferable.
No Show Policy
If a patient misses a scheduled appointment, without giving 48-hour notice to the office, a $70 no-show fee will be charged to your account. If the appointment was scheduled for a procedure and not canceled, the charge is $150. If the office is closed, we will accept a voicemail 48 hours before. If a patient cancels or reschedules less than 48 hours prior to their appointment, you understand that you will still be charged the $70 fee because you did not give 48-hour notice. For Aesthetician appointments, there is a $20 no show/same day cancellation charge. For Aesthetician procedures a $70 no show/ same day cancellation charge will be applied.
We understand that emergency situations do happen. We will be happy to reschedule your appointment for a future date. If you do not call to reschedule appointment 48 hours prior, you will be charged $70.
If a patient misses two appointments or more, the patient will be dismissed from the practice.
Late Fee Payment
If a patient's balance remains unpaid for sixty-one days, a $20 late fee will be added to the account balance. Each month after that an additional $20 late fee will be added until amount due is paid. Excessively late claims that remain unpaid are eligible to be sent to a collections company (including the original amount due and all late fees accrued) and may appear on your credit report. (see below)
If a patient's balance remains past due for ninety days, the account may be turned over to a collection agency. If collection proceedings occur, the patient or the responsible party will be held accountable for attorney fees, court costs, and all other collection fees.
FINANCIAL POLICY REGARDING INSURANCE
1. IT IS THE PATIENT'S RESPONSIBILITY TO KNOW THEIR INSURANCE POLICY DETAILS, NOT THE RESPONSIBILITY OF DERMATOLOGY ASSOCIATES, PC
2. IT IS THE PATIENTS RESPONSIBILITY TO CALL THEIR INSURANCE COMPANY TO MAKE SURE THAT DERMATOLOGY ASSOCIATES, PC IS IN NETWORK.
3. IF YOU ARE OUT OF NETWORK (FOR EXAMPLE: ANTHEM MEDICARE PRODUCTS) YOU UNDERSTAND THAT YOU WILL BE RESPONSIBLE FOR A LARGER PORTION OF YOUR BILL PER YOUR INSURANCE. HOWEVER, YOU ARE STILL ABLE TO BE SEEN BY DERMATOLOGY ASSOCIATES, PC.
4. IF YOUR INSURANCE REQUIRES YOU TO HAVE A REFERRAL OR PRIOR AUTHORIZATION, IT IS THE PATIENT'S RESPONSIBILITY TO KNOW THIS AND OBTAIN THIS FROM YOUR PRIMARY CARE DOCTOR.
REFERRAL= FROM YOUR PRIMARY CARE DOCTOR'S OFFICE
PRIOR AUTHORIZATION= FROM YOUR INSURANCE COMPANY
Telemedicine is a service offered by Dermatology Associates, PC for virtual dermatology visits. Self-pay patients will pay for the visit at the time of scheduling. If a patient misses their appointment, they will be charged accordingly to the financial policy. The patient is ultimately responsible if their insurance does not cover their Telemedicine visit claim. We ask that you check with insurance before scheduling that your Telemedicine with Dermatology Associates, PC is covered. The insurance company’s reimbursement amount varies.
I have read or had read to me, and understand the above information. I understand that I am financially responsible for any balance amount not covered by my insurance, as well as any co-pay, deductible and co-insurance left over balances. A copy of this financial policy has been made available to me.