Fees, Insurances & Billing
Clarity Acne & Aesthetic Dermatology

Thank you for choosing Clarity Acne and Aesthetic Dermatology. We are committed to building a successful provider-patient relationship with you. Your clear understanding of our Patient Financial Policy is important to our professional relationship and payment for services is a part of that relationship. Please verify all demographic and insurance information at each visit, or through the Remedly patient portal.

General Policy

We ask that you do not discuss your account balance or other financial aspects or your care with the providers or medical staff. Please discuss any account information and any questions about our fees, our policies, or your responsibilities with the Clarity Concierge at the reception desk or with our practice administrator.

Proof of Insurance

Please bring your current insurance card and a government issued photo ID, i.e. driver license, passport, etc. If you fail to provide us with the correct insurance information in a timely manner, you may be responsible for payment of the charges for services rendered.

Payment for Services

All deductibles, co-payments, co-insurance and past due balances are due at the time of service. If you do not have a co-pay, we will charge a $50 fee-for-service that will be applied towards your deductible and collected before at the time of your medical visit. Cosmetic specials and referral programs do not apply to medical appointments.

You are responsible for any balances that may be due as a result of coinsurance or co-payments, annual deductible amounts. Non-covered services, out-of-network charges, terminated coverage, exhausted benefits, no insurance coverage, failure to respond to insurance company correspondence or inquiries, fees related to nonpayment, missed appointments, returned checks & other fees.

In addition, we offer an additional financial option called Advance Care with a separate entity, online at www.advancedcarecard.com or call 1.800.432.9470. Customer service hours are Monday through Friday 8am to 5pm EST. We have no control over your interest rate, amount of credit, approval or denial, or billing disputes; therefore, you should contact Advance Care directly. Please, ask the registration staff for a brochure at the reception desk. Otherwise, you will be required to pay your balance in full at time of service. We may require a deposit depending on services provided, which will be explained at the time of your consult. Consultation fee of $75 will be applied to the cost of your services and or products purchased. Subject to terms and conditions.

Insurance Coverage

Insurance is a contract between you and your insurance company. It is the insurance company that makes the final determination of your eligibility and benefits, and it is your responsibility to know and understand your insurance policy and benefit coverage.

Acne and Aesthetic Dermatology is not responsible for knowing your insurance policy and which services are eligible for coverage.

Our office will bill your primary and secondary insurance company as a courtesy to you. We allow 45 days from the date the claim is filed for the insurance company to pay. If the insurance company does NOT pay within this time, you will be responsible for the entire balance. We will not become involved in disputes between you and your insurance company regarding coverage and/or policy benefit criteria, i.e. deductibles, non-covered service, co-insurance, coordination of benefits, or pre-existing conditions.

In order to properly bill your insurance company, we require that you disclose all insurance information to our office, including primary and secondary insurance, as well as any change of insurance information. Failure to provide complete insurance information may result in a denial of payment and you will then assume responsibility for all services rendered. In addition, your insurance company may need you to supply certain information directly in order to process a claim. It is your responsibility to comply with their request. If your insurance company does not pay for any part of the services performed for you at our office, you will be responsible for the complete balance of the non-payable services. If we are out of network with your insurance company and your insurance pays you directly, you are responsible for payment and agree to forward the payment to us immediately. In special cases, we may need your help in contacting your insurance company for the payment of your services and therefore you must agree to fully cooperate in assisting us should that be necessary.

Insurances Accepted: Anthem, Optima, Cigna, Aetna, United. All others are considered out of network.

Insurances Not Accepted: Medicare, Medicaid, Tricare – or other government insurance forms.

Since we are a specialty, it is your responsibility to obtain a referral through your primary care provider. Absence of a referral may result in you not being seen and or being billed forthe full amount of charges. If you have questions regarding your insurance coverage, call the number provided on your insurance card.

For cosmetic services, we will provide you with a waiver of liability stating that we nor you will request reimbursement through insurance.

Assignment of Benefits

Your agreement indicates that you request that payment of authorized benefits be made on your behalf to Clarity Acne and Aesthetic Dermatology for any services furnished to you by the providers, employees and associates of Clarity Acne and Aesthetic Dermatology. You assign your right to receive these payments to Clarity Acne and Aesthetic Dermatology and authorize Clarity Acne and Aesthetic Dermatology to file an appeal on your behalf for any denial of payment and/or adverse benefit determination related to services and care provided. If your insurance carrier and its agents will not direct payment to Clarity Acne and Aesthetic Dermatology, you agree to forward to Clarity Acne and Aesthetic Dermatology all health insurance payments, which you receive for the services rendered by Clarity Acne and Aesthetic Dermatology providers, employees and associates. You authorize Clarity Acne and Aesthetic Dermatology or any holder of medical information about you to release to the insurance carrier and its agents any information needed to determine these benefits or the benefits payable for related services. You acknowledge that this authorization will be valid for all subsequent visits unless cancelled in writing by you or an authorized agent.

By agreeing to our financial policy you designate Clarity Acne and Aesthetic Dermatology as an authorized representative to act on your behalf in regard to claims submitted to any employee health plan or other source of Third-Party Coverage for Services rendered by Clarity Acne and Aesthetic Dermatology. This designation includes, but is not limited to, initial determinations, requests for documents, requests for additional information and appeals. You further authorize Clarity Acne and Aesthetic Dermatology to execute any documents necessary to process claims for reimbursement of charges for services provided to you.

Pathology/Laboratory

Skin biopsy samples are routinely sent to a third-party laboratory for microscopic evaluation to determine or confirm proper diagnosis. In some circumstances, a consultation with another laboratory may be requested by your provider. You authorize and understand that you are responsible for the cost of any testing or laboratory services performed and that billing of such services may be billed independently by another provider or laboratory if your insurance doesn’t pay or you are a self-pay patient.

Laboratories we routinely use are LabCorp, Bon Secours, and Sentara.

Clarity Acne & Aesthetic Dermatology is not responsible for charges from third parties. This is your responsibility to settle all accounts with third parties as directed by their financial policies.

Medical Prior Authorization

Many insurance plans require prior authorization for procedures such as skin biopsies, excision, and treatment of warts and molluscum. Therefore, after your initial evaluation, we may ask you to schedule a follow-up appointment for treatment in order to allow our staff the time to obtain the prior authorization. If you wish to proceed with treatment on the same date as the initial evaluation, you will be asked to sign a ‘waiver of liability’ indicating that you accept financial responsibility for any fees associated with the procedure(s) performed.

Non-Covered Services

Insurance plans will not generally pay for the fees associated with removal or treatment of benign skin lesions such as normal moles, angiomas, seborrheic keratosis, and skin tags. If you wish to have a benign skin lesion removed or treated, you accept financial responsibility for any fees associated with the procedure(s) performed. We will not bill your insurance.

Missed Appointments

We require 24-hour notice of appointment cancellation. If you do not show for a scheduled office visit and you did not provide our office with at least 24 hours’ notice, you will be charged a fee of $50. If you do not show for a scheduled procedure (e.g. laser procedure, skin biopsy, electrodessication and curettage, or excision) and you did not provide our office with at least 24 hours’ notice, you will be charged a fee of $100. If services rendered are $500 or greater you will be charged 50% of the procedure cost. Payment of any outstanding no-show fees will be required to schedule another office visit. Patients who no-show and/or fail to cancel two appointments with at least 24 hours’ notice may be dismissed from the practice.

Returned Checks

The charge for a returned check is $35, payable by cash or money order. This will be applied to your account in addition to the insufficient funds amount. You may be placed on a cash-only payment basis following any returned check.

Methods of Payment

Our office accepts cash, check (with proper identification), debit cards, advance care card and major credit cards (MasterCard, Visa, American Express and Discover) and PayPal.

Outstanding Balance Policy

It is our office policy that we will attempt to notify all past due accounts three times. If no resolution can be made, the account will be sent to a collection agency and the patient will be dismissed from the practice.

In the event an account is turned over for collections, the person financially responsible for the account will be responsible for all collection’s costs, including attorney fees and court costs. Regardless of any personal arrangements that a patient might have outside of our office, you are ultimately responsible for payment of the service. Our office will not bill any other party.