This
office has contracted with your insurance plan and agreed to accept
a lower fee schedule as payment. It is our office policy not to give
away any services for patients covered under a discounted plan. Your
insurance will not pay for the following:
___Your office visit/consultation fee if any procedure is done on
the same day
___All possible cosmetic/plastic/reconstructive surgery without
prior authorization and medical review
___Treatment of non-healing sores with wound care without prior
authorization and medical review
___Treatments with PUVA
This means that your plan requires more than one visit for any
procedure. We apologize for any inconvenience. We will provide
all services required as long as we are reimbursed for each one.
This only applies to covered, medically necessary services.
Procedures that are cosmetic are not covered under your plan and do
not have these restrictions.
Procedures are anything beyond an exam, and may include
injections, treatment of growths, biopsies and surgery.
Prior authorization/Medical review is the requirement
that the specialist send a report and/or office notes to the
insurance company before they will agree to pay for a procedure.
Possible cosmetic/plastic/reconstructive surgery is
defined by the insurance company to include all skin lesion
treatment except those that are definitely malignant.
Skin lesion is every skin growth including removal of
moles, warts, growths, skin cancers, fatty tumors and all keratosis.
Contracted describes the relationship between the doctor
and the insurance company where the doctor agrees to follow all the
rules laid out by the plan.
Precertified or Pre-approved is the agreement to pay our
fee given by the insurance plan after Prior authorization/Medical
review if the procedure is allowed.