Financial Policy and Waiver
Insurance: If we participate with your insurance carrier, our office will file a claim on your behalf for all charges. In the event your health plan determines a service to be “non-covered”, the patient will be responsible for all charges. Many insurance policies require a coinsurance payment by the patient for certain surgical procedures. This percentage amount will be due PRIOR to surgery.
We cannot file your insurance unless all of your insurance information is given at the time of your visit. It is therefore necessary for us to have a current copy of your insurance card for accurate billing. Insurance benefits will be verified by our office, but it is recommended that you educate yourself about your individual benefits by contacting your insurance company before being seen. It is required that we hold you responsible for your portion of the charges, including copays and deductibles, at the time of service. If your insurance company has not paid a claim within 60 days, you may receive notification in the mail requesting your assistance in determining if there is a problem, or if additional information is required in processing the claim.
If we do not participate with your insurance carrier, your account is considered a Self-Pay account. Payment is required in full at the time of service for all services including surgeries. Your insurance company will be billed as a non-assigned claim as a courtesy to you. The insurance company will reimburse you directly on a non-assigned claim. In the event that we receive payment for a non-assigned claim, you will receive a full refund within 30 days.
Medicare: We are a participating Medicare provider. We will bill Medicare on your behalf. If you have secondary coverage, we will send a claim to your secondary carrier however, if no payment is received within 60 days, you will be sent a bill and will be responsible for the balance. If you do not have secondary coverage you will be expected to pay any co-pays, coinsurance, and deductibles at the time of service.
Co-Pays: All required co-pays will be collected at check-in PRIOR to being seen by the physician. In the event of an adolescent coming to an appointment without a parent, it is the parents’ responsibility to see that the co-pay is sent with the patient. Any additional fees that may be due as a result of unpaid deductibles and/or procedures performed as the visit will be collected at check-out. If a patient does not have their co-pay at the time of visit, we will be happy to reschedule their appointment.
Non-Covered Services : There are a number of services we provide that are typically considered “cosmetic” by your insurance company. For example, removal of some benign growths such as skin tags are not routinely covered by health insurance plans. Other services, such as Botox, fillers, chemical peels, and laser, are also considered not medically necessary. Full payment for all non- covered services must be made at the time of your visit.
Self-Pay: A $400 deposit is required PRIOR to an office visit for patients that are new and do not have health coverage. All established patients that do not have health coverage there is a $300 deposit required. All procedures will require payment in full at the time of service. If you are concerned about the cost of a procedure, a member of the billing staff will be happy to discuss with you.
Authorization of Payment and Release of Information: I request payment of authorized insurance benefits be paid to Dermatology Specialists of West Georgia. P.C. (d/b/a West Georgia Dermatology) and authorize release of medical information to determine payable benefits for services rendered.
Authorization to Keep Credit Card on File: I hereby authorize Dermatology Specialists of West Georgia. P.C. (d/b/a West Georgia Dermatology) to keep my debit or credit card information on file for payment and to initiate appropriate payment entries against my debit, credit card, or bank account as applicable, as amounts are owed by me on the patient account. I acknowledge that the initiation of all such entries to make payments on the patient account must comply with the provisions of U.S. law and any applicable state laws. I understand and agree that these entries may be made to my debit, credit card, or bank account as applicable, periodically to pay amounts owed by me on the patient account. I also agree to notify Dermatology Specialists of West Georgia. P.C. (d/b/a West Georgia Dermatology) if my debit or credit card information changes for any reason. This authorization shall remain in effect until I communicate to Dermatology Specialists of West Georgia. P.C. (d/b/a West Georgia Dermatology) my intention to cancel this authorization by calling the business office at (770) 838-9333.
Referrals: Since we are a dermatology office in the state of Georgia, referrals are not usually required. If your insurance company does require a referral, it is solely your responsibility to obtain a current referral for office visits. A valid referral must be received at least 48 hours prior to your appointment, or you may be asked to reschedule.
Labs: If you are aware that your insurance carrier requires you to utilize certain labs for blood work or biopsies, you must inform your nurse. There are charges related to the laboratory itself, and these charges are separate from our office charges. You will receive an explanation of benefits (EOB) from your insurance carrier. You may receive two statements – one for your office visit and one for laboratory services from an independent dermatopathology laboratory.
Surgery/Cancellation Policy: We understand that there are times when you must miss an appointment due to emergencies. Due to the large block of time needed for surgery; last minute cancellations can cause problems and added expenses for the office. If surgery is not cancelled 24 hours prior to your surgery time you will be charged a fee of $75.00. For all other appointments, there is a $50.00 fee charged for appointments that are not cancelled 24 hours prior to the appointment. This is fee is not covered by your insurance and will be your responsibility.
Procedural terminology: We have had many questions from patients when they receive their EOB (explanation of benefits) from the insurance company and the word “surgery” is used in conjunction with a charge. Please be aware that ANY procedure done in a physician’s office may carry the name “surgery” on an EOB. This refers to the type of code only and not surgery in the traditional sense of the word. This is true of the freezing of warts, removal of skin tags, shave biopsies of lesions, etc. These procedures also usually fall under the “surgery” category when your deductible and/or coinsurance benefits are considered.
Minor Children and Adolescent Patients: The parent or adult who brings the child or adolescent to the office is responsible for payment at the time of service whether the account is self-pay, participating or non-participating insurance. It is the parent’s obligation to send payment with the individual bringing the patient.
Any adolescent under the age 18 must have a parent or guardian with them for the initial visit. On succeeding visits for the same problem, the patient may come to an appointment without a parent however it is the parent’s responsibility to send any co-pay, coinsurance, or other amounts due at the time of service with the patient. Adolescent patients presenting without their required co-pay will have their appointment rescheduled.
Returned Checks: There is a $ 55.00 fee for all returned checks.