Financial Agreement
At McLean Dermatology and Skincare Center, we are committed to providing the best dermatologic care.
Please note: This agreement must be signed in order to be seen by providers at McLean Dermatology and Skincare Center
OFFICE FEES AND PAYMENTS
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There are fees for all services performed by our providers and staff, including consultations and procedures.
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As the patient or guarantor, it is your responsible for all charges for your visits, including co-payments, deductibles, and coinsurance amounts that are due per your insurance plan.
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Cosmetic services cannot be processed through insurance, and fees for such services are due at the time of service. Allbsales are final.
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General dermatology services will be processed through the insurance on file or billed directly to the patient if we dobnot have insurance on file.
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If there is a balance due after insurance pays for your visit, the difference owed is patient responsibility.
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Charges for all visits and procedures that are not processed by insurance are due at the time of service.
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Medicare patients are responsible for any bala{signature}{signature}nces due for services that are not covered by Medicare.
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If you have an outstanding balance on your account, it must be paid in full before your next visit.
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We accept cash and all major credit cards. We do not accept checks.
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For any NSF check (checks returned for non-sufficient funds), a $50 NSF charge will be billed to your account.
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If proof of insurance is not provided at the time of service, you are responsible for the entire fee for the consultation and/or procedure at the time of service, and a $150 service fee for retroactively billing your insurance.
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In the case of an account overpayment, a credit will remain on your account unless you request a refund.
INSURANCE POLICIES
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Your insurance policy is a contract between you and your insurance company. It is essential that you understand which services and procedures are covered by your insurance plan and obtain any necessary authorizations or referrals prior to your appointment with us.
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We accept plans through the following payers as in-network providers: UnitedHealthcare, Cigna, Medicare, Virginia Health Network, Carefirst BlueCross BlueShield, First Health, and PPO plans by Anthem Blue Cross Blue Shield.
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We cannot guarantee that we accept your specific plan as an in-network provider; it is your responsibility to verify your insurance benefits and coverage prior to your visits.
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We will not submit claims to any other insurance company other than those listed above. If you have a secondary insurance in addition to one of the plans listed above, we will file a claim to your secondary insurance as an out-of-network provider. In such instances, we cannot guarantee complete coverage.
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If we do not accept your insurance, the charges for all services are due in full at the time of service. All sales are final.
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Please note: several United Student Resources plans do not cover hair loss visits; verify your coverage and benefits prior to your visit so you are aware of your plan benefits and limits.
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It is your responsibility as the patient to understand your insurance plan limits and restrictions that affect coverage of services you receive.
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If you have biopsy or any lab testing in our office, you and/or your insurance will be billed for the corresponding lab’s charges. The lab is a third party and will bill you for remaining balances.
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If your insurance company requires you to use a specific laboratory in order for laboratory fees to be covered, it is your responsibility to request this.
48-HOUR CANCELLATION POLICY
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You will be billed a $50 “No Show/Cancellation Fee” for each consultation cancelled or missed without 48-hour notice, or $150 for all missed Saturday appointments without 48-hour notice.
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You will be billed a $150 “No Show Fee/Cancellation” for all procedure appointments cancelled/missed without 48-hour (Excisions, lasers, Botox, fillers, etc.)
COLLECTION AGENCY
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In the event it is necessary to refer your account to a collection agency, you will be responsible for all fees of any collection agency, which may be based on a percentage at a maximum of 30% of the debt, and all charges accrued, including attorney fees, court costs, late fees, an 8% interest fee, and all McLean Dermatology and Skincare Center PLLC administrative fees.
By signing this agreement you acknowledge that you have received and read the Financial Agreement, and dully understand and accept the terms of the McLean Dermatology and Skincare Center Financial Agreement.