Thank you for choosing Wesley Chapel Dermatology for your care. The following is a statement of our financial policy. We want you to understand it and be comfortable with it. We require that you read it and sign it prior to receiving evaluation or treatment from us. Please do not hesitate to ask questions or discuss any concerns
Forms of Payment: We accept HSA, FSA, VISA, MasterCard, American Express and Discover. Check & Cash are not accepted
Credit card on File: We ask that you place a credit card on file with our office (see our Credit Card on File policy)
Fees Collected on the day of service: Copay is due on the day of service. If you have plan with deductible or co-insurance, estimated patient responsibility is due on the day of service. Please understand that amount collected from you on the day of service is estimate only. Once your Insurance carrier processes your claim, we will bill you for the remaining balance as per our Card-on-File Policy.
Patients with Insurance: We bill your insurance carrier as a courtesy; ultimately you are responsible for the full charges of your visit. Your insurance policy is a contract between you and your insurance carrier. Since we are not party to that contract, you are responsible for understanding how your insurance. We do not routinely research why an insurance carrier has not paid or why it paid less than anticipated for your care. If your insurance carrier declines a claim due to inaccurate or incomplete information you have provided to us or to them, we may still bill you directly for the unpaid balances. We are not obligated to wait for you to resolve a dispute with your insurance carrier before seeking payment from you. As a courtesy, we will help you as best we can to get proper and timely payment from your insurance carrier.
We will file your insurance promptly and we agree to wait for 45 days for reimbursement. If after 45 days, we have not received payment from your insurance company we will contact you and allow you 15 days to settle your account. Subsequently, the entire balance will be transferred to Patient’s responsibility
Referrals: If your insurance policy requires a referral from your primary care physicians, it is your responsibility to have the referral faxed to our office prior to your appointment. You are responsible for any charges not paid by your insurance policy due to failure in securing the Referral
Lab Charges: You may receive a separate bill for laboratory or pathology services from an off-site lab for any tests your physician may order. Please discuss any billing errors or discrepancies with that laboratory.
Minor Patients: A parent or legal guardian must accompany minors for all visits. The parent/guardian who accompanies the patient for the initial visit becomes the responsible party. In cases of divorce or separation, the parent authorizing treatment for the child will be the parent responsible for those charges. If the divorce decree requires the other parent to pay all or part of the costs, it is the authorizing parent’s responsibility to collect from the other parent
Insurance Takebacks: Insurances sometimes perform takeback on the payments previously issued to the Physician. Sometimes these Takebacks occur more than a year after the patient visit. In such cases, we will send you a Bill on the takeback amount. You agree to pay us the takeback amount. You should contact your insurance directly for any questions on insurance’s takeback determination.
Others: There may be a $25 fee for the completion of any paperwork. There is a fee for copying medical records: $1.00/page for the first 25 pages and .25 for every page thereafter