NEW PATIENT FORMS
To simplify your initial visit, please download and print the forms below, fill out and bring with you.
Co-pays and Insurance Cards are due at the time of service. Please be prepared to present and/or pay the co-pay to the receptionist at each appointment. The balance of your account is due upon billing of the monthly statement. An account balance over 60 days is considered past-due and finance charges are assessed. Patients with no insurance are required to pre-arrange their payment in full before their appointment or make a deposit at the time of service with a payment schedule for the remaining balance. If you need additional assistance, please call 952.374.5992 for our Billing department.
INSURANCE COVERAGE OF OUR SERVICES
Dermatology PA tries to belong to as many insurance plans as possible. There are many unique and new plans that are changing frequently. We depend upon the patient to determine whether your insurance company does or does not cover a specific service or procedure. Please understand that we cannot accept responsibility for payment or nonpayment of your insurance claims, nor can we negotiate a settlement on a disputed claim. Questions about coverage and benefits are between you and your insurer.
If your health plan requires a referral in order to receive care at Dermatology, P.A., it is your responsibility to make sure an appropriate referral has been requested prior to your visit. If you do not obtain a valid referral from your primary care physician, and your health plan does not pay for our services, you will be responsible for payment.
We strive to see all patients who schedule appointments with us and to stay on-time. However, we know things can come up in your schedule to change your appointment and require patients to give us 24-hour notice of a change. We are happy to reschedule your appointment. Be advised that you will incur a self-pay $50.00 charge if we do not receive this notice. Thank you for helping us to remain accessible to you and others!