PATIENT INFO

Under Federal HIPAA regulations, we will release information from your medical record to your insurance carrier if required in order to process our claim for services we provided; to your primary care physician or other referring physician(s) to provide continuity of care; and in certain other circumstances specifically permitted by HIPAA rules, without prior written authorization from you.

If you wish to have us release information from your medical record to other individuals or organizations, you will need to sign an authorization specifying the information to be released and to whom it is to be released. There may be a charge for release of information in certain circumstances.

If you are in need of medical records please click on the link below to complete an authorization form. Once the form is completed please contact our office 202.293.3990, option 3 to complete your medical records request and payment. Please email your completed form to IDKSmedicalrecords@mydermgroup.com and allow for at least 2-3 business days for our office to process your request.

MEDICAL RECORDS RELEASE FORM

It is critical that we have correct demographic (personal) information about you and about your health insurance coverage in order for us to bill accurately for the services we provide to you. This information includes:

• Your complete name, address, and phone number
• The name of your insurance company, the group and subscriber number or other identifying numbers
• Your insurance company’s claims filing address and telephone number
• A COPY of your insurance card, which also shows important information about your plan
• For those who have an insurance plan that requires a referral we will need the name, address and phone number of the physician (usually your PCP who is referring you to our office)

At each visit, we will verify your demographic information and scan a copy of your driver’s license (or other valid photo ID) and, for patients with insurance, your current insurance card for your primary and (if applicable) secondary insurance. This is to ensure accurate billing information and to protect you by confirming that we are providing services to the correct individual. Please understand that our staff will ask for this information and these documents even if you have recently been seen in our office. If you do not provide us with the needed information in a timely manner, you may be responsible for payment for services rendered.

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While we understand that personal circumstances sometimes make it necessary for you to cancel your appointment, please notify us as soon as you know you will not be able to keep your appointment. Short-notice cancellations and missed appointments or “no-shows’ prevent us from offering the appointment to other patients wishing to be seen, particularly for cosmetic, surgical and Mohs slots.

Appointments not cancelled at least two business days in advance are considered “late” cancellations for cosmetic, surgical and Mohs slots. Appointments not cancelled at least one business day in advance are considered “late” cancellations for general dermatology slots.

A frequent pattern of appointment cancellations and/or visit “no-shows” makes it impossible for our providers to provide appropriate continuity of care, and may result in a patient’s discharge from our care.

• $50.00 Fee for cancellation of a General Dermatology appointment.
• $100.00 Fee for cancellation of a Cosmetic or Surgical appointment.

PLEASE NOTE – For patients scheduled for cosmetic appointments, more specifically and not limited to Sculptra if you do not cancel your appointment within two business days, you will be charged for the product and/or will lose your deposit. Sculptra can cost several hundred dollars, with the exact cost varying depending on the are treated.

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• $25.00 Fee for Medical Records to be processed and sent via USPS
• $10.00 Fee for Medical Records to be processed and picked up in office

There may also be times when you request that we complete forms of various types; examples may include medical histories for life insurance applications, disability forms, lawsuit claims etc. If your provider is able to complete a short form during a scheduled office visit, there is no additional charge. However, if the form is long or complicated, will require additional time outside of the scheduled visit to complete, or if you are not being seen for a scheduled office visit, there will be a $25.00 charge, payable in advance, for completion of each form. Please understand that completion of such forms requires time by our providers and staff in order to ensure that they are completed accurately. It may also take several days before the form is available for pick-up if your provider is not available for completion and/or signature at the time of your request, so please allow sufficient time before the form is needed.

Insurance plans With Which We Participate – We are participating providers with many of the major commercial insurance plans, including CareFirst BlueCross BlueShield, Federal BlueCross Blue Shield, Anthem BCBS, Humana, Aetna, Cigna, GHI, Multiplan, United Healthcare, Coventry, Tricare and Medicare Part B, amongst others.

Insurance plans With Which We Do Not Participate – We are not participating providers with include Amerihealth, Kaiser Permanente, Medicaid, and Cigna Sure Fit, amongst others.  

For questions about whether we participate with or accept your insurance plan, please contact our office 202.293.3990, option 3 for assistance.

HMO Plans – If your insurance carrier is an HMO plan with which we do not participate, but your plan includes an out-of-network option, we will be happy to schedule your appointment. However, you will need to sign a waiver acknowledging that we are non-participating and agreeing to be responsible for payment of amounts not paid by your plan. You may have a deducible, higher copayments and/or coinsurance – meaning you have a higher amount you have to pay – than if you were to see an “in network” provider.

If we do not participate with your HMO plan and your plan does not have an out-of-network option, you will be considered “self-pay” and the full cost of the appointment will be due the day of your appointment.

Verification of Insurance Coverage – We will verify your insurance coverage at the time of your visit. If your insurance coverage changes after you schedule your appointment, please notify us as soon as possible, before your visit. If we are not able to confirm active coverage, you will be considered “self-pay”. It may be necessary to reschedule your visit, depending on the services requested, whether or not you are able to make payment at the time of the visit. [Please see the section entitled AMOUNTS DUE FROM YOU for further information and options.]

Referrals – Your insurance plan may require a referral from your primary care physician (PCP) in order for us to see you for a visit. Under the terms of your coverage, it is your responsibility to obtain the appropriate referral prior to your visit. Some plans have an “Open Access” option under which you may choose to see a specialist without a referral. However, in certain plans you will have a higher copayment and/or coinsurance for an open access visit – meaning you have a higher amount you have to pay – than if you obtain a referral for your visit.

If your plan requires referrals but does not have an Open Access option, and you do not have a valid referral at the time of your visit, we will be happy to reschedule the visit for another date so that you may obtain a referral from your PCP.

In compliance with our contracts with our participating insurance carriers, we cannot obtain a referral after services have been provided. We also cannot contact your primary care physician’s office to request a referral when you arrive at our office for your visit; this delays other patients who are waiting to be seen, and your PCP’s office is not always able to respond to our request immediately.

Please make sure to contact your PCP in a timely manner to obtain needed referrals prior to your visit (check with your PCP to find out how much in advance notice they require to prepare the referral, and if they need to see you for a visit before they will issue a referral). Please bring a physical copy of your referral to your scheduled appointment or e-mail your referral to IDKSreferrals@mydermgroup.com.

Insurance Pre-Authorizations – In some cases an additional approval called a pre-authorization or pre-certification is required by your insurance carrier for certain prescriptions. Our Medical Assistants will work with your insurance carrier to obtain the prescription. If you are in need of a pre-authorization for a prescription, please call 202.293.3990, option 4 to speak to a Medical Assistant.

Our providers follow current dermatology standard of care and appropriate-use guidelines in recommending procedures and treatments as part of your care. Please be aware that some of the procedures or treatments recommended for you by our providers may be determined to be non-covered or may be considered “not medically necessary” based on the benefits provided by your specific insurance plan. You will be financially responsible for the costs of non-covered services and services that your insurance carrier declines to cover as “not medically necessary”.

In the event that our information indicates that a specific service or services may not be covered by your plan, you will be asked to sign an ABN, or Advanced Beneficiary Notice, outlining the services that we have determined may not be covered by your plan, and for which you agree to be responsible for payment, before we will provide those services to you.

Please understand that even for insurance plans with which we participate, covered benefits may vary from one person’s or employer’s plan to another, and it is impossible for us to know what is covered under every plan. You are responsible for knowing the covered and non-covered benefits available under your plan. If you have questions, contact your employer’s personnel department or your plan directly.

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Copayments – You are responsible for paying your copayment at the time of each office visit. Copayments are part of your contract with your insurance carrier, and in order to keep our billing costs down, we are unable to bill you for your visit copayments in lieu of payment at the time of your visit. [It is also a violation of our contract with your insurance carrier for us to “waive” copayments in the absence of documented financial need.] We are aware that insurance companies sometimes do not assess a copayment, or assess a different copayment, when they process the claim. However, we must rely on the information we receive when we verify your insurance benefits, and we therefore collect the copayment amount specified by your insurance carrier’s benefit verification.

If you are unable to pay your copayment at the time of your visit, we will be happy to reschedule the visit for another date.

Deductibles – Most Commercial plans also include an annual deductible amount that must be paid by the patient before the plan pays any benefits, and many people now have high-deductible health plans (HDHPs), with annual deductibles that can be thousands of dollars. [Although many plan deductibles re-set at the beginning of the calendar year, other plans may re-set in a different month. Check with your plan to find out when your deductible “year” begins.]

If you have not met your deductible, your insurance carrier will process the claim towards your deductible, but will not make any payment to us, and you will be responsible for payment of the contractual amount approved by your plan. Because of this, it is our policy to collect your contractual copayment and sometimes an additional $75.00 upon checking-in. Even if you believe you have already met your deductible as a result of medical services from other providers, those services may not have been processed by your insurance plan and your deductible may not yet show as having been met when we verify your coverage.

If you are unable to pay your applicable deductible at the time of your visit, we will be happy to reschedule the visit for another date.

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We understand that paying for out-of-pocket medical costs can be financially challenging. We accept cash, personal check, and Visa, MasterCard, Discover and American Express credit and debit cards, as well as FSA and HSA debit cards, for all patient payments (please do not send cash payments through the mail). In the event of a returned check, a $30.00 service charge will be added to your account to cover fees assessed by our bank.

How to pay – Mail in a payment to our Boca Raton, FL billing office [Integrated Dermatology of K Street PO Box 865393 Orlando, FL 32886-5393] or submit payment via our online payment system, link provided below.

PAY ONLINE

We Accept Care Credit – Click here for more information or to apply today.

Self-Pay Balances After Insurance – If you have insurance but have a balance remaining after your insurance carrier processes the claim (due to copayments not identified through insurance verification, unmet deductibles, coinsurance and/or non-covered services), you will receive a statement from our offsite billing department based in Boca Raton, FL. Your statement will show itemized charges, insurance payments and adjustments, any patient payments, and remaining balance due. Payment is due upon receipt, and may be made by personal check, our online payment system or credit card as listed above.

Refunds – In the event a patient’s payment results in an overpayment or “credit balance” on your account, the overpayment can be refunded to the patient as soon as all payments posted to the account have been verified and any unpaid dates of service have been resolved.

Please contact us if you find that you are having difficulty meeting your payment obligations. If you do not communicate with us, we cannot work with you to establish a reasonable payment agreement.

If the self-pay balance on your account is 90 days or more past due, if you do not contact us about your balance or respond to our efforts to contact you, and/or if you do not make agreed-upon payments when we have approved a short-term payment plan, your account balance will be subject to placement for outside collection.

Our providers strive to provide you with the best in dermatologic care – but their knowledge and expertise is about your medical needs, not about insurance billing, and they will direct you to our Billing Office with your billing questions.

Our Business Office billing and financial counseling staff is based in Boca Raton, FL and are experienced and dedicated to ensuring that the charges for your medical care are billed promptly and accurately. If you need assistance or have further questions, please contact our Business Office at (866) 650-0276 between 9:00am and 4:00pm Monday through Friday. We will make every effort to resolve your questions.