APPLIED DERMATOLOGY, PC

Financial Agreement

THIS NOTICE DESCRIBES YOUR FINANCIAL OBLIGATION TO APPLIED DERMATOLOGY, PC. PLEASE REVIEW IT CAREFULLY.

We can only submit claims to insurance carriers with which we are contracted. You will be responsible for any balance remaining. The most recent list of contracted insurance carriers can be found here.

If Applied Dermatology, PC participates with the primary insurance plan under which you are covered, your primary insurance company will be billed for all services rendered. If we also participate with your secondary plan, we will bill your secondary carrier following receipt of primary carrier’s contracted adjustment. We expect payment up front for any and all of the following as they apply to each individual: 1-Unmet Deductible 2-Co-Insurance 3-Co-payment 4-Prior Balance 5-Charges for all non-covered services or cosmetic services.

If you do not have health insurance, have insurance through a carrier that does not contract with Applied Dermatology PC, or if your coverage is currently under a pre-existing condition clause, payment in full is expected at the time of your visit. Although we strive to notify our patients of charges that are commonly denied as uncovered services, it is impossible for us to determine what each individual plan may or may not cover. You are responsible for payment of any charges deemed not covered by your plan(s).