F.A.Q. Billing and Insurance
Q. What insurance does Dr. Clark accept?
A. Dr. Clark is considered an in network provider with Blue Cross Blue Shield, Oxford and United Healthcare. Dr. Clark is a non-participating provider with Medicare. As a Medicare patient you pay a discounted Medicare fee at the time of service. We submit all claims to Medicare and the patients are reimbursed directly by Medicare. Please allow 30-45 days for reimbursement.
Q. Do I need an insurance referral?
A. Some insurance companies require a referral from either your primary care physician or from your OB-GYN. If you have an Oxford plan that requires a referral you can request an electronic referral be entered in order to see Dr. Clark by speaking with either of these types of physicians. Dr. Clark's provider ID for Oxford is P582109. If your Blue Cross Blue Shield insurance requires you to obtain a referral you can have a paper referral sent to our office at 212.888.0930. Dr. Clark's provider ID for Blue Cross Blue Shield is 34E381. If a referral is required it must be obtained prior to your appointment in order for you to be seen.
Q. What is a copay/coinsurance/deductible?
A. Many insurance companies require a patient cover a certain amount of their visit. It may be a copay, which is a set amount predetermined by your insurance company that the patient pays at each visit. Dr. Clark is a specialist. If you have a specialist copay you would be responsible for the copay at the time of service for each visit. A copay is usually between $10.00 and $75.00 per visit.
Some insurance companies require that a coinsurance be paid. A coinsurance is a percentage of the “allowable” amount determined by your insurance company. Usually it is between 10% and 20% for either office visits or procedures performed. Coinsurance often varies from visit to visit and for this reason it is not usually collected at the time of service. You will be billed once your insurance company has processed the claim for what they consider to be the patient responsibility. Prompt payment of this invoice is appreciated.
The fees for our service will be applied towards your deductible is applied when you have not met your insurance company’s annual deductible, a preset dollar amount that must be paid by the member before insurance will reimburse for any services provided. With a deductible you are responsible for the full “allowable” amount (the amount “allowed” by your insurance company for a service) after it has gone through processing at your insurance company. We ask all patients who have a deductible to leave a credit card on file for any past invoices that become delinquent (30 days past due). Once your claim has been processed by your insurance company you will receive an invoice for the amount due for your visit with us. Prompt payment of this invoice is greatly appreciated.
Q. What forms of payment does Dr. Clark accept?
A. Cash and checks are preferred method of payment. We also accept all major credit cards.
We accept Care Credit and Alphaeon credit for cosmetic procedures over $1000.00
Q. Is an annual skin cancer screening considered preventative care?
A. Dermatology currently does not fall into the “annual preventative medicine visit” umbrella. All annual skin checks are subject to your copay, coinsurance, and or deductible. There are no billable CPT codes that meet the preventative care guidelines. This is not our policy nor preference but rather has been determined by the insurance carriers.
Please visit http://www.uspreventiveservicestaskforce.org/uspstf09/skincancer/skincanrs.htm for more information.
Q. Is my visit/procedure covered by my insurance?
A. Insurance pays for visits and procedures based on medical necessity. All medically necessary procedures and visits are billed to your insurance. When covered by the insurance carrier it will either be paid at the contracted rate and it may be subject to the copay, coinsurance, and/or deductible. If it is processed and applied to your deductible it has been “covered” by insurance.
Patients are responsible in full for all visits/procedures that are considered cosmetic and not medically necessary.
We hope the answers above have been helpful.
We are happy to answer any further questions you may have. Please contact us via e-mail at [email protected] or call us at 212.750.2905 with any questions or concerns you may have regarding billing, appointments, or medical questions.