faq: billing + insurance

Frequently Asked Questions about Billing + Insurance

Will my skin cancer screening be covered as “preventative”?  

• The only cancer screenings that are covered under the preventative care benefits are: breast, cervical and colorectal cancer screenings. Skin cancer screenings are generally not covered under your preventative care benefits.  

• Any applicable copays, deductibles and/or coinsurance would apply to skin cancer screening appointments.

• Approved preventative services are under the direction of the US Preventive Services Task Force. They have not added Skin Cancer Screenings to their recommended preventative service list, therefore insurances do not recognize these services as preventative.

Why am I receiving extra bills for my pathology or laboratory services? 

• Pathology Services: If you have a tissue biopsy done, you will receive a separate bill from the pathology lab (often Yale Dermatopathology Laboratory) in addition to your bills from Modern Dermatology, as their pathologists perform the analysis of the tissue. Modern Dermatology will bill for the biopsy procedure itself. There may be times where additional diagnostic testing needs to be done at a reference lab to support the diagnosis; therefore, you will receive an additional bill for these services if applicable. When you consent to biopsy you are agreeing to these associated costs, which cannot be predicted or influenced by Modern Dermatology. 

• Laboratory Services: If you receive laboratory services, such as blood tests, you may receive a bill from the laboratory (often Quest Diagnostics or Labcorp Laboratories), as they perform the analysis of the lab specimen.

I have been a patient for years; why is my visit billed as a “new patient visit”? 

• The American Medical Association and your insurance give physicians a specific set of codes that we can use to bill for office visits. These codes indicate that a new patient is any patient that has not been seen within the last three years.

How do I know if my insurance will cover my visit or surgery? How much will it cost?

• Coverage varies with each insurance company, so please refer to your insurance member handbook or call your insurance company with questions about what's covered. Deductibles, Coinsurance and Copays will be applicable for covered services.

• Good Faith Estimates can be offered upon request; estimates given are a general quote of benefits and are not a guarantee of payment. Actual payment is known once your insurance company completes the claim process. They will directly share an EOB (Explanation of Benefits) with you explaining payment responsibilities (either the insurance company, the insurance policy holder/patient, or combination of both).

• You should always check with your insurance company regarding your specific benefit coverage.

When will I receive a bill? When am I responsible for my bill?

• If you have given us complete insurance information and we are in-network with your insurance, you will not receive a bill until your insurance:

• paid the claim and there is a coinsurance, copay, deductible, or non-covered service for which you are responsible

• denies the claim

• notifies us that information is needed from patient before claim can be processed

• determines your coverage is not valid or cannot be verified for the date the services were provided

• Statements are mailed to the patient address on file or texted to the mobile number on file if a verified email address is available for second level of authentication. Feel free to share with our desk team if you have a preference and they can alert our billing company.

What is a referral or prior authorization?

• Some insurance plans require a referral when seeking care from a specialist. A referral is completed by your primary care physician and is sent into your insurance company. It is your responsibility to obtain any necessary referrals. A referral DOES NOT guarantee payment from your insurance company. If a referral is not supplied, the patient will be fully responsible for the visit fees.

• Modern Dermatology will work with you and your insurance company to obtain prior authorizations for certain services. A prior authorization means that a proposed medical visit/treatment is medically reasonable and necessary. A prior authorization DOES NOT guarantee payment from your insurance company.

What is a deductible, coinsurance or copay?

• Deductible: the amount that you must pay for before your insurance begins to pay. These amounts can change every year. The office cannot negotiate payments assigned as patient responsibility by your insurance company.

• Coinsurance: an amount you may be required to pay as your share of the cost of healthcare services after you pay your deductible. Coinsurance is usually a percentage (for example: 20%).

• Copay: an amount you may be required to pay as your share of the cost for health care services. A copayment is usually a set amount, rather than a percentage. (for example: $60 office copay). Dermatology is a specialist field, so the specialist co-pay amount will be applied.

If you have a question about our Insurance, Payment and Financial Policies, please click here.