This is a friendly reminder of our Pre-Appointment Checklist:
- Please remember to bring your insurance card and ID to your appointment. If you are unable to provide these at the time of your appointment, we will not be able to see you that day. *Sometimes, what you think is cosmetic is actually a medical treatment (e.g. acne or pigmentation disorder) that requires a Doctor’s decision making or prescription medication. If this happens we will treat your visit as a medical visit and send it to your insurance. If you have a co-pay or deductible it will apply to your medical visit.
- If you are scheduled for a cosmetic consult with the Doctor, there will be a $50 consultation charge that will go towards any cosmetic procedures or products you purchase that day.
- We are no longer accepting cash as a form of payment. We take all credit cards (Visa, Mastercard, Discover, Amex), CareCredit, checks, and money orders/cashiers checks.
- Please make sure to read this page in its entirety, below it discusses what you may or may not be responsible for through your insurance coverage. We will ask that you sign the below consent upon arrival.
We understand that “life happens”, however in order to be respectful of the medical needs of all our patients, we ask you to review our attendance policies below. Appointments are in high demand, and your early cancellation will help another person have access to timely medical care.
We require All Paperwork, Insurance, and Final Confirmation of your appointment to be done at least 24 hours prior your appointment for us to prepare for your visit. If you do not confirm your appointment and complete paperwork ahead of time, your appointment will be cancelled. We apologize for any inconvenience that will cause and we will try our best to reschedule your appointment as soon as possible.
*If you are unable to complete your paperwork online you must arrive 30 minutes prior to your appointment to complete in our office.
If you are unable to make your appointment, please call 24 hours in advance to cancel. Failure to do so will result in a $50 “No Show” fee that will need to be paid before your next appointment is scheduled. Please be aware that Monday appointments must be cancelled by noon on the previous Friday. Again, we apologize for any inconvenience that will cause and we will try our best to reschedule your appointment as soon as possible.
Insurance Coverage for Procedures Handout
If you have ANY deductible within your insurance plan, (medical, surgical, and/or laboratory) patient will be responsible for any and all parts of the bill as deemed by your insurance company.
As you know, Dermatology is considered a specialty in the medical world. With that, come more tedious insurance requirements and specifications that the payers incorporate into each individual plan. With all the plans that are available today, such as:
- Strictly Copay plans: Any services that are rendered in our office have a fixed amount that will be paid in full at the time of every appointment. (Usually higher premiums)
- Strictly deductible plans: Any services that are rendered in our office have a fixed contracted allowable amount which is to be fulfilled by the patient prior to insurance coverage kicking in. (Usually lower premiums)
- Office Copay’s & surgical deductible plans: a combination of the above two types of plans. (Usually mid-level premiums)
**Insurance Payers deem certain medical services as surgical. Meaning, if you have any type of deductible within your plan, they would count towards that. Such services in dermatology include but are not limited to; surgery, biopsies, destructions/freezes, injections, PDT, and UPT’s.
Exclusion: Office visits that include verbal treatment plans, over the counter drug recommendations, prescription drug management will also fall under the deductible for the plans that are strictly deductible.
It is vitally important for patients to understand the INS and OUTS of their individual plan. Such information can be found out by simply calling the number on the back of your insurance card prior to your appointment and asking them for the specifics of your plan in regards to a specialist office.
Other things that you may want to verify with your insurance company prior to scheduling your appointment due to certain exclusions that may exist within your plan:
- Treatment for the following:
- Hair Loss
- Corns and callouses
- Any laboratory deductibles that you may have, in the event that any biopsy or excision is done that require a reading to be performed by a pathologist (specialty).
Benign Lesion Removal Handout
In selected circumstances, the removal of benign lesions (examples: seborrheic keratoses, epidermoid cysts, moles (nevi), acquired hyperkeratosis, molluscum contagiosum, milia, viral warts, benign neoplasms, hemangiomas, lipomas and pyogenic granulomas) is medically appropriate. Therefore, Medicare will consider their removal as medically necessary, and not cosmetic, if one or more of the following conditions are present and clearly documented in the medical record:
- The lesion has become symptomatic or has undergone a change in appearance or displays evidence of inflammation or infection.
- The lesion obstructs an orifice.
- The lesion clinically restricts eye function. For example, the lesion
- Restricts eyelid function/Interferes with vision
- Causes misdirection of eyelashes or eyelid
- Restricts lacrimal puncta and interferes with tear flow
- Touches the globe
- There is clinical uncertainty as to the likely diagnosis, particular where malignancy is realistic consideration based on lesion appearance or prior biopsy of a related or similar lesion suggesting malignancy.
- A prior histological exam or biopsy suggests or is indicative of atypia (e.g. atypical nevus) or malignancy.
- The lesion is in an anatomical region subject to recurrent physical trauma and there is documentation that such trauma has occurred.
- Removal of molluscum contagiosum.
- Benign epidermal or pilar cyst with history of infection, drainage, or rupture.
- Wart removals will be covered under guidelines above. In addition, wart destruction will be covered when any of the following clinical circumstances are present:
- Periocular warts associated with chronic recurrent conjunctivitis thought to be secondary to lesion virus shedding
- Warts showing evidence of spread from one body area to another
- Lesions are condyloma acuminatum
It is normal to experience recurrence of a benign lesion after its removal. Every recurrence would be considered a new lesion and would not be discounted or included in a previous office visit or payment.
If these lesions/moles are not deemed medically necessary, they would be considered cosmetic and the patient would be responsible. The prices are as follows:
- Benign Lesions:
- 1-2 lesions: $30.00
- 3-5 lesions: $75.00
- 6-10 lesions: $150.00
- Additional 1-10: $150.00
- Mole Removal: (Will have additional pathology fees of $75.00/mole)
- 1st mole: $150.00
- Each additional mole: $50.00
Cryosurgery is the treatment of lesions with the application of a cold substance. In most cases, liquid nitrogen is used to destroy the lesion(s). Liquid nitrogen is so cold, -196◦ Celsius, it burns as it is applied.
A biopsy is a surgical procedure used to obtain a sample of tissue for microscopic examination to aid the physician in diagnosis. The entire lesion may not be removed in this procedure. The tissue obtained in this biopsy procedure will be examined by a pathologist. Further medical or surgical treatment may be needed when the diagnosis is made.
By signing below I am confirming that I have read and understand all above handouts that include: INSURANCE COVERAGE FOR PROCEDURES, BENIGN LESION REMOVAL, CRYOSURGERY, and BIOPSY HANDOUT.
I understand that I may receive a separate bill from the pathologist or laboratory.
I understand that a biopsy requires obtaining a sample of tissue and is a surgical procedure.
As in any surgical procedure, there are certain inherent risks including bleeding, post-operative pain, infection, reactions to sutures, anesthetics or topical antibiotics, and scarring.
I understand that cryosurgery treatment uses liquid nitrogen and sometimes a permanent white mark, or scar, will be left after healing.
Complications include but are not limited to the following:
- Allergic reaction to the anesthesia or surgical antiseptic
- Need for more surgery
- Hematoma (collection of blood)
- Seroma (collection of fluid)
Although all reasonable efforts will be made to minimize the possibility of these potential complications, no guarantees can be made since many factors beyond the control of the physician (such as the degree of sun damage or patient compliance with post-operative instructions) affect ultimate healing.
You may choose to decline having a procedure, however, the risk of no treatment could be:
No improvement, decline in quality of life, spread of skin concern, spread of cancer, death.
I hereby authorize and direct Dr. Hooper and/or Dr. Jackson with assistants of her choice to perform a biopsy, cryotherapy, or benign lesion removal upon myself/child, including any necessary or advisable anesthesia. I further authorize the doctors to perform any other procedures that in their judgment are advisable for my wellbeing. I am advised that though good results are expected, the possibility and nature of complications cannot be accurately anticipated and therefore there can be no guarantee as to the result of the procedure or as to cure.
I state that I have read and understood the consent process; all questions about the procedure have been answered in a satisfactory manner. I certify that the procedure and risks were explained prior to my signature.