At EpiDermatology our Billing Department strives to maintain a high degree of professionalism and transparency during the billing process. Before contacting us regarding your specific billing concern we encourage you to read our Billing FAQ, which is a compiled list of the most commonly asked questions and answers our department receives from patients.
How much will it cost to see the dermatologist?
The cost of your visit with your dermatologist will vary depending on the type of visit and scope of treatment involved. You can expect to be charged for an office visit which entails a discussion with the doctor for the reason for the visit, an exam of the area involved, and a brief to an extensive history of the nature of your concern. Any test and/or procedure that may be performed during this encounter will be billed at an additional charge(s). Should you request additional information at the time of your visit or before an upcoming procedure/surgery, our staff is available to provide a benefit check and discuss your potential out of pocket costs.
How do you decide how much to charge?
Each office visit, test, and the surgical procedure is assigned a corresponding code (called CPT codes) developed by the American Medical Association (AMA). These codes are used by ALL insurance plans, including Medicare, to process your medical claim. Each code is assigned a relative value developed by HCFA based on medical expertise to perform service, geographic location, operating cost, and liability. The practice obtains these codes annually and adjusts our fees accordingly, so we are competitive and in line with other dermatologists in the area.
Will my doctor discuss fees with me during my visit?
The physicians at California Dermatology Physicians focus on practicing good medicine. They will recommend treatments based on what is best for the condition you are presenting. In most cases, the physicians are not aware of the fees as they don’t want it to be a conflict of interest when discussing the best course of medical treatment for you.
How can I know how much the visit will cost me if I have any tests and procedures?
Be familiar with your health insurance benefits. Know how much your deductible/co-insurance or co-pay is in advance. Ask your doctor what codes he/she is going to submit to your insurance plan and ask for a Patient Advocate to give you an estimate of the cost. The Patient Advocate can give you the cost of the codes before the procedure(s) is done. With this knowledge, you can anticipate your out of pocket expenses before you check out of the office. Remember that deductible amounts are due at the time of service and must be collected.
Why didn’t my insurance company cover my visit?
All insurance companies have the same disclaimer: “Coverage is not a guarantee of payment”. The term ‘covered’ is different than that of ‘payment’. ‘Covered’ when referring to medical services means that your insurance is going to allow the service(s) received and will process your claim according to your specific plan benefits. Reasons for non-payment could be any of the following, just to name a few: non-covered service, deductible, co-insurance or cost share, co-pay, plan exclusion, etc. As an example, often times the office visit will be allowed and paid by the insurance plan but the procedure performed that same day is applied to the deductible. Given the number of insurance companies and the numerous networks and benefits packages, it is not possible for us to offer you exact assurances as to what your benefits are. Questions regarding your specific benefits are better directed to your health insurance plan.
What is a deductible? What is co-insurance or cost share?
A deductible a fixed amount you agree with your health insurance plan to pay out of pocket each year for covered (allowed) health care costs before they begin to pay. For example, if you have a $1000 deductible, you will be responsible for paying for the first $1000 in healthcare expenses out of pocket before your insurance company begins to pay. After the deductible has been satisfied there may also be an amount due from you called a co-insurance or cost share amount. This term refers to an amount you may be required to pay as your cost share for certain covered services. This amount is usually calculated as a percentage.
What if I am unable to pay in full at this time?
We accept all major credit cards. We also have interest free payment plans available to assist you in budgeting for your health care costs. Most require some upfront payment but allow for automatic monthly payments drawn from a valid checking account in your name. We are committed to working with you so that you can receive the high-quality healthcare you deserve.
The doctor spent 10 minutes with me and squirted some liquid nitrogen on my wart. I feel the charge is too high considering the treatment didn’t even work.
The fee is not based on time alone and takes into consideration the doctor’s expertise and skill, risk factors, supplies and resources required to perform the procedure. Warts, in particular, are caused by a virus of which there is no known cure. Whether warts are treated or not they may go away and then reappear. It may take multiple treatments before you see any change.
Why am I being charged for a biopsy from your office and for pathology from somewhere else?
In order to provide optimum service to all of our patients there may be times it is necessary for the doctor to send the specimen(s) to an outside dermatopathologist if there is a question about the diagnosis. In coding as created by the AMA, all biopsies have two parts – the Surgical Component and the Pathology Component. The biopsy is taken and prepped in our office and then sent out for interpretation. A report is generated by a dermatopathologist which is then sent back to your doctor. California Dermatology Physicians will charge for the Surgical Component (administering of anesthesia, the medical services of the physician taking the biopsy). The outside dermatopathologist will charge for the interpretation and report, called the Pathology Component.
The doctor removed one lesion from my back. Why am I being charged for another surgery to repair it? Why is it not one charge?
There are two parts to this type of procedure – the removal of the lesion and the repair. The type of removal chosen is dependent on several factors such as size, location, and diagnosis (benign or malignant). The type of repair functions similarly. The procedure is required to be billed in two parts (removal and repair) because each has specific criteria to meet per CPT coding guidelines.
My bill says my claim was denied but my insurance company is different than the one listed.
If this is the case you should call our office immediately to resolve this issue. If you changed insurance companies and forgot to inform the staff when you came in for another visit we will do everything we can to get the claim processed by your new insurance company. However, the longer you wait to contact us, the harder that will be. Any amounts owing due to failure to provide correct billing information at the time of service are the responsibility of the patient.