INSURANCE. It is your responsibility to understand the terms, guidelines and limitations of your insurance plan. Please advise us of any changes to your insurance, address or phone number. A current, valid insurance card and driver's license or photo ID must be presented prior to each visit. If you are unable to present an insurance card and photo ID or if you are covered by an insurance plan with which we are not contracted, full payment will be required in advance. Prior to your visit, we will attempt to verify your insurance is active and anticipated financial responsibility as received from Availity or the insurance site. Your payment obligation is set by your insurance plan. We do not know if you have exlusions to your policy nor can we ensure your insurance will cover your desired service. If for any reason your insurance company does not cover your visit, you will be responsible for 100% of the charges billed. Co-pays, unmet deductibles and co-insurance are collected at the time of service.
REFERRALS. If a referral is required, it is your responsibility to obtain one and have it at our office prior to your visit or you may be held responsible for all charges related to the visit.
SELF-PAY OR COSMETIC SERVICES. Payment is due in full at the time of service. Lincoln Road Dermatology accepts American Express, Visa, MasterCard, Discover, Apple Pay and cash for all transaction amounts.
CREDIT CARD ON FILE (CCOF) & BILLING CYCLE. Lincoln Road Dermatology requires a credit card, debit card, HSA or FSA at the time of booking or upon check in. Your information will be held securely until your insurance(s) pays their portion of the medical claim. You will be sent an explanation of benefits from your insurance detailing your financial responsibility. Any remaining balance will result in a text message payment request from our accounting team. You can submit payment via our website. After 2 billing attempts, our staff will reach out for payment for charges above $100. All charges under $100 will be charged to your CCOF.
If your CCOF changes, expires, or is denied for any reason, you agree to immediately give Lincoln Road Dermatology a new, valid card that will replace the previous card on file for future transactions and the same Credit Card on File policy will apply. You can call our billing company or your insurance at anytime to contest or understand your balance. Our credit card policy went into effect August 15, 2022.
Refusal to comply with CCOF: existing patients can be seen one last time by paying in full prior to having services rendered at our office. All new patients must comply with CCOF to establish care.
REFUNDS. In the instance of overpayment, our accounting team issues refunds to the credit card of payment on a monthly, rolling basis. If your EOB shows an overpayment, kindly call our office if you have not received an email indicating a refund was already issued.
DEPOSITS. Deposits may be requested for extended visit times are as follows: $50 deposit for medical visits, $75 for 45 min esthetic visits, $150 for microneedling, laser resurfacing or 2 hour esthetic visits. Pricing is subject to change.
CANCELLATIONS AND MISSED APPOINTMENTS. Missed appointments and late cancellations (collectively termed “missed appointments") prevent us from providing care to another patient in need. Cancellations must be made 24 hours in advance of your scheduled appointment to avoid a missed appointment fee of $50 for medical or a $75 for surgical, esthetic, or cosmetic visits and will be charged to your credit card on file if no deposit or credit is available on the account. There are no exceptions to this policy. While our office does send several text message and email reminders prior to your appointment, missed appointments due to failure to receive a message will still be charged the appropriate fee. Repeated missed appointments may result in discharge from the practice. You are considered a missed appointment if you are 15 minutes past your check in time. We do not guarantee we will be able to accommodate any patients who arrive more than 15 minutes past their scheduled appointment time, even in the event of notifying our office of a potentially delayed arrival. We reserve the right to reschedule your visit if you arrive 10 minutes past your check-in time. Kindly aim to arrive 10 minutes prior to your scheduled time so that we may run on schedule.
MEDICAL RECORDS REQUESTS. You may be charged a fee for any medical records that you request from our office in accordance with the Florida Judicial Code. You may retrieve your own medical records free of charge via our online Sadio Health Portal. Details are on our website and our staff is happy to help you gain access.
RETURNED CHECK FEE. We do not accept checks at our office. If a check is sent via mail to settle a debt and is returned for insufficient funds, a fee of $35 will be charged for any checks returned for insufficient funds.
OUTSTANDING BALANCES. Outstanding balances are payable upon receipt of your explanation of benefits or billing statement (now texts). Should your account become 60 days past due, the unpaid balance will be charged to your credit card on file. If unable to obtain your balance, it may be turned over to a collection agency. A fee of 35% of the outstanding balance will be added to your account if it is referred to collections.
WHAT TO EXPECT AT YOUR VISIT?
Efficiency. Your appointment time is reserved just for you. We value your time and strive to be an office that sees patient in a timely manner. You are expected to arrive at least 10 minutes prior to your scheduled appointment time to update your electronic chart and consent to treatment. A medical assistant or your physician will then be ready to conduct the scheduled visit for your stated concerns.
Prepare ahead. You can update your profile online at Sadio.com prior to your arrival to avoid delays but will still verify all medical information entry upon arrival. Always leave your name as it appears on your insurance card (no nicknames). Have readily available your medication list, including supplements, and medical conditions.
The Consultation. All visits should assume to be for consultation only. All procedures will be planned only after doctor has assessed your condition in consultation and can be planned accordingly. Estimations of costs and coverage can be done in advance of future surgical scheduling dates.
-IMPORTANT: There is no guarantee that any procedure will be done at the same booking as a consultation. A consultation is required prior to any surgical services rendered by the physician.
-Acute concerns can be addressed in a brief visit. These includes treatment of warts, acne, skin rashes, fungal infections, and many other STDs.
-We will make every effort to get existing patients in for a skin cancer concern or other urgent concern.
-Extensive visits require focus and attention. These include hair loss, skin cancer screening and patch testing or severe, chronic skin condition flares like psoriasis and eczema. If too many concerns are presented in one visit, we reserve the right to prioritize your health concerns and schedule a second appointment for further evaluation and management.
Skin cancer screening is a comprehensive visit distinct from all other acute issues and concerns. It should be scheduled separately from any “list” of issues or specific concerns. A yearly skin exam is recommended for most adults over 20 and those with family or personal history of skin cancer, numerous moles, history of excessive sun exposure or tanning beds.
- Prepare for you skin cancer screening- you should arrive to our office without nail polish, makeup, or self-tanner. It is best to leave any jewelry at home. You will be asked to remove as much clothing as you are comfortable with and don a robe.
- Inspection of the hair, nails, and all cutaneous surfaces from head to toe, including the genitalia is performed using a dermatosope or handheld microscope. You will be palpated or lightly touched for any tumors or growths, such as lymph nodes, just beneath the skin.
- If you are uncomfortable with the thought of having any specific area of your skin evaluated, kindly inspect this area prior to your appointment to ensure there aren’t any concerns which you could be addressed at your visit. We will work within your comfort level to ensure the most comprehensive exam.Please make our medical assistant and doctor aware of any specific areas you would like omitted or have concern for.
Procedures involve any cutting, freezing, injecting, burning, lancing or breaking of the skin. Procedures are separate and distinct from consultation costs. Good faith estimates will be given prior to performing any procedures.
Laboratory and Pathology Services. Laboratory fees are distinct and separate from the above services. Lab services include processing of skin samples done during your visit (bacterial or viral culture or skin surgeries or biopsies) by an outside, 3rd party. We are unable to adjust or alter these charges. Please contact the lab directly to discuss any concerns.
Prescription management. Prescriptions expire at 1 calendar year from when the initial prescription was written. A medical visit is required thereafter.
-Sound medical practice requires that patients return to the office for important follow up appointments, monitoring, and evaluation of the effectiveness of the medication. In some cases, a limited supply will be given based expected response. If you are not responding as expected, you are expected to return for possible change in prescription management or reevaluation.
-If you wish to change your pharmacy for active refills, call your current pharmacy holding your prescription to facilitate transfer of any active prescriptions.
Prior authorizations. We reserve the right to charge $50 or bill for time associated with extenuating prior authorization processes (this commonly happens with Botox for sweating, and psoriasis and eczema injectables or branded oral medications) due to the extensive time it takes our staff and doctor to fight on your behalf for your medication. Please utilize websites such as GoodRx.com for drug coupons to avoid the run-around imposed by prior authorizations.
By signing this document, I, the patient or guardian or legal representative of patient, guarantee payment of all charges for medical treatment and services provided to me (or my dependent) by Lincoln Road Dermatology. This includes evaluation and management, procedures, cosmetic services that may be required during my visits or planned visits, including copay, deductible and co-insurance responsibilities, as well as missed medical appointments and deposits. I have read the above policy with respect to insurance billing, need for referrals, self-pay, card on file, cancellations and missed appointments, medical records, returned check fee and outstanding balances policies above. I agree to email and text reminders of amounts owed or refund notices. I understand that the missed appointment fee is not covered by my insurance and no non-urgent future bookings will be granted unless my account is kept current and has a valid credit card on file.
I have familiarized myself with the expectations of an efficient medical visit.
I understand that this form will replace any previously signed financial policy.