Insurance Benefits
Prior to your office visit, we contact your insurance company to request benefits for services that will be performed in our office. The benefits that are quoted to us are not a guarantee of payment. Payment will be determined at the time the claim is processed by your insurance company and is based on the specifics of the claim. Please be advised that if you make a payment in the office at the time of your visit, depending on how the claim is processed by your insurance company, you may or may not be responsible for additional payment. If additional payment is required, you will receive a statement with the specifics of the charges from our office and payment is due upon receipt.

Referrals
Most managed care insurance plans, such as HMO’s, require patients to obtain referral authorization from their primary care physician in order to see a specialist. As the patient, it is your responsibility to know whether or not your plan requires a referral. It is also your responsibility to request a referral from your primary care physician in the event your insurance does require referral authorization. You will need a valid authorization number in order for us to accept and process your referral.

Financial Payments
Some insurance plans require patients to pay out-of-pocket for services that are rendered to them. Co-payment, deductible and/or coinsurance may apply to EVERY visit according to the terms and conditions of your insurance plan. As a patient, it is your responsibility to know if a co-payment, deductible and/or coinsurance applies to your insurance plan. It is also your responsibility to remit payment of any out-of-pocket fees at the time of your visit. You are also responsible for payment for services that are not covered by your insurance plan such as cosmetic procedures or other procedures. In the event of an overpayment, you will receive a refund from Rose Dermatology for the amount which was overcharged.

Co-payment: It is your responsibility to make full payment of your co-payment. Your co-payment amount is determined by your insurance carrier and the amount charged will be for services rendered by a specialist. Payment is required at the time of your visit, before seeing the provider.

Deductible: It is your responsibility to make payment toward your deductible. Your deductible amount is determined by your insurance carrier and the amount charged will be for services rendered by a specialist according to the fee schedule of your insurance carrier. Payment of your deductible is required at the time of your visit.

Coinsurance: In the event that a coinsurance applies, you will be billed for any amount that your insurance carrier determines to be your responsibility.

Cancellation/No Show Policy
At Rose Dermatology, we value you as a patient. When we book appointments we designate a specific time for you to receive the necessary care and treatment you deserve. We understand that situations arise at which time appointments may need to be cancelled. Each time a patient misses or “NO SHOWS” an appointment without providing sufficient notice, another patient is prevented from receiving care. Therefore, we request that you give us no less than 24 hour notice for cancellations.

Office appointments which are cancelled/rescheduled with less than 24 hour notice will be charged a $20 cancellation fee. Patients who do not show up for their appointment without a call to cancel will be considered as “NO SHOW” and will be charged a $20 “NO SHOW” fee. Cancellation/NO SHOW fees are the responsibility of the patient and payment must be made at the time the appointment is cancelled and before any future appointments can be booked.

Medical Record Release
Your medical records, as per HIPPA laws, are strictly confidential. No information will be released without your written authorization to do so. If you want your records released, you must sign a medical record release form. Please allow at least 1 to 3 business days for records to be sent via fax or mail. Please be advised that we cannot send confidential medical records via email. There is an administrative fee of $10 if you are requesting your entire medical record be sent to you.

Patients Without Insurance Coverage
If you are a new patient, you will be required to pay a consultation fee for the services provided to you. Fees for services will be collected at the time services are rendered. Please be advised that if a procedure is done and a specimen is sent to the laboratory for processing, you will receive a separate bill from the laboratory. The bill you receive from the laboratory is not for services rendered in our office but, for the diagnostic testing of the specimen that was collected in our office and sent to the lab for testing.

Adult Patients with Minor Children
If you are an adult patient and are bringing your minor child along, you must bring the child(ren) with you into the exam room. Unaccompanied minors cannot be left unattended in the waiting area.

Minor Patients
Patients under the age of 18 MUST be accompanied by a Parent or Legal Guardian.

Service Animals
Service animals are defined as dogs that are individually trained to do work or perform tasks for people with disabilities. The use of service animals by patients is protected by the Americans with Disabilities Act (ADA). It is unlawful to restrict the use of a service animal without reasonable cause. If you require the use of a service animal, the animal must be harnessed, leashed or tethered unless this interferes with the animal’s tasks or the person’s disability. Service animals are allowed to assist their owners as long as they do not interfere with the care of the patient in which case we have the right to require that the patient be without their service animal.

Food Policy
We are considerate of patients and staff with food allergies. Please note our office is nut, peanut and shellfish free.