Forms and Policies

Other Forms:

 

Scheduling & Financial Policy — Effective January 1st 2019.

 

I understand the following policies set forth at Integrative Dermatology:

SCHEDULING POLICY

  • Time based appointments. Appointments are scheduled based on time. These start at 10 minute visits, available for follow up patients only, and increase in 10 minute increments. You may refer to the “Pricing” section of our website which explains how to schedule, or call for staff guidance on how to schedule the most appropriate amount of time to address your concerns.

  • Time requirements. A minimum of 11-20 minute appointments are required for skin biopsies. A 21-30 minute appointment is required for complete, comprehensive skin exams.

  • Extending your appointment. If your appointment needs are beyond the scheduled amount of time, we will happily extend your appointment if time allows and you will be charged for the next highest time slot. We will, however, never cut into another patient’s appointment and will always strive to run on time in the interest of valuing all patient’s time.

  • Tracking time. We will keep track of your appointment time and advise when that time is complete.

  • Tardiness. Patients arriving late to their appointment will be seen for the remainder of their appointment time, but will be financially responsible for the entire appointment.

  • No-show. Appointments missed without 24-hour notice will result in a $60 charge. One exception to this is an emergency and these are determined on a case-by-case basis at the discretion of our office.

  • Online scheduling. Integrative Dermatology uses Acuity online scheduling system. We have signed a business associate agreement with Acuity, which is a legal contract that describes how the business associate (Acuity) adheres to HIPAA and protecting your information. You can access their full privacy policy at https://acuityscheduling.com/privacy.php.

FINANCIAL POLICY

  • Insurance Free Practice Model. Integrative Dermatology is a direct care practice, meaning we do not participate with any private or government healthcare agency. Patients pay Integrative Dermatology directly for the care they receive.

  • Medicaid, Medicare, Medicare Supplements and Tricare. We do not participate in any government healthcare program. You may not submit claims to Medicaid, Medicare, Tricare or any of its supplements for services provided at Integrative Dermatology. Medicaid, Medicare and other government insurance programs will still cover any medications or testing prescribed by Dr. Veerula as per your policy.

  • Private Contract. All patients seen at Integrative Dermatology must engage in a private contract before services can be rendered. This contract states that Integrative Dermatology does not make any representations that any fees paid to Integrative Dermatology are covered by your health insurance or other third party payment plans that apply to you. Dr. Veerula has opted out of Medicare and does not participate with Medicaid, and as a result, these agencies cannot be billed for any services performed for you by Dr. Veerula at Integrative Dermatology. You agree not to bill or attempt reimbursement from Medicaid, Medicare or any government insurance for any such services.

  • Payment. Payment in full is required before any services are rendered. Cash, Visa, MasterCard and Discover are accepted forms of payment. A credit card on file is required to book some appointments, but is not charged unless there is a violation of our cancellation policy. In some instances, a deposit must be collected to reserve your appointment. You will be notified beforehand if this is the case.

  • HSA/FSA. Health spending (HSA) and flex spending (FSA) accounts are accepted for all medically necessary services.

  • General Dermatology Fee Schedule. A fee schedule is posted on the website and available at the office upon request. Fees are subject to change at any time without notice.

  • Cosmetic Fee Schedule. Cosmetic services are billed under a separate fee schedule. As always, payment is due at the time of service. However, some planned, larger procedures may be charged before services are rendered. We will not charge your card without first discussing your charges with you.

  • Pathology Fee. Prices exclude pathology cost. We have negotiated discounted fees for pathology, approximately 70$/specimen, with preferred labs or you may choose to get pathology billed through your insurance.

  • Other Fees. Occasionally, there may be an additional fee for staff time, administrative work, or other extra tasks that are done on your behalf. We will inform you BEFOREHAND if extra fees are involved. These include medical coding fees (5$ per request) and prior authorization work for prescriptions (25$).

  • Changes to Fees. Fees are subject to change at any time without notice.

  • Insurance Reimbursement. For privately insured patients, upon request, we can provide the necessary information for you to file a claim with your insurance company (there is a small charge to cover the physician’s time). However, we cannot guarantee that your insurance company will reimburse you. All questions regarding your insurance coverage and reimbursement should be directed toward your insurance company or benefits manager.

  • No-show and Cancellation Fee. In the interest of valuing everyone’s time, we require a 24- hour notice for cancellation. Kindly follow the instructions for cancellations for our online scheduling system or call us to cancel/reschedule as necessary. Missed visits without 24-hour notice will result in a charge of $60.00 fee. At the time of scheduling some select appointments, we will require a credit card to be on file via our secure US Pay or other credit card processing company. You will be notified at the time of booking if your appointment requires a credit card on file. The credit card required for booking will NOT be charged unless there is a no-show or cancellation in less than 24 hours. Your office visit fee will be charged upon arrival at your appointment at Integrative Dermatology. Exceptions to the cancellation policy are made for emergencies and decided on a case-by-case basis at the discretion of Integrative Dermatology.

  • USPay and Other Credit Card Processing. We use USPay for online payment, analytics, and other business services, including in-office charges. USPay collects identifying information about the devices that connect to its services. Stripe uses this information to operate and improve the services it provides to us, including for fraud detection. You can learn more about USPay and read its privacy policy at ______. Their privacy policies can be accessed via the following links



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