Insurance is designed to help you meet the cost of medical services but the responsibility for payment is ultimately yours.
Billing & Insurance
Dermatology Associates participates in the following insurance plans:
Aetna Medicare Advantage
Anthem Blue Cross Blue Shield
Connecticare Medicare Advantage Plan
Harvard Pilgrim Health Plan
Optum Network of Connecticut
United Healthcare Medicare Advantage
Understanding Your Healthcare Costs
Health insurance benefits are an important part of your healthcare experience. At Dermatology Associates, we want to help each patient maximize their individual benefits and strive to ensure each patient feels comfortable with the insurance billing process.
It is the goal of our dedicated billing department to assist patients in understanding their visit services and insurance coverage. Ultimately, each individual person’s insurance plan is very different and it is not possible for us to know all the parameters of each plan. It is important that patients research, review, and comprehend their insurance benefits so that they are familiar with their own deductibles, copays, coinsurances, prescription plans, and other spending limits or restrictions they may have. It is also extremely important to check things like your provider’s in-network or out-of-network status, or if your plan requires you to have a referral for your visit prior to making your appointment with us.
Important Key Terms
The amount you pay for (cost of) your health insurance or plan each month.
The amount you owe for covered health care services before your health insurance or plan begins to pay toward them during the plan year. The total amount of your deductible varies from plan to plan. Each time a claim is filed with your insurance for a covered service, the payment that you make for that visit will be applied toward your deductible balance until you reach $0. Deductibles are yearly, many starting over in January, but the plan can begin any time of the year.
A payment you may make for certain health care provider visits and prescriptions. You may have a different copay amount for primary care doctor visits vs. specialist doctor visits. Your plan also may not have copays at all.
A percentage amount that your insurance requires for medical services. Some plans have coinsurance costs for certain services and some plans may only begin charging coinsurance after your deductible has been met. For example, 80/20 plans are common, where you would be responsible for 20% of the cost of a service you received, while your insurance plan pays the other 80%.
This is the maximum amount that you will pay toward medical services during your plan year. This includes everything you pay toward your deductible, copay, and coinsurance. Once you reach your out-of-pocket maximum amount, your plan will pay 100% of medical costs.
An electronic form that is submitted on the patient's insurance company website by the patient's primary care physician to see a specialist.
These terms and definitions are for information purposes only and may vary by insurance company/plan.
When you visit our office, we bill for any services that are performed at your appointment. Some of these may be insurance eligible (i.e., covered by insurance), some may not. Although a service may be covered by your insurance plan, it does not necessarily mean that you won't have to pay anything. Your insurance plan may have a deductible, copay, or coinsurance that you are responsible for. It may also be that the service was not covered by your plan. In any event, our billing team is here to help you understand your bill.
There are a variety of reasons that a visit or a particular service wasn't covered. It may be that your specific plan does not cover the service that was provided at your appointment. It could mean that your insurance company has made an error when processing your claim. It is also possible that while our office accepts your insurance type, the provider you saw for your visit is considered out of network for your specific plan. It may be the confusion that because you received a bill from us, that your service wasn't covered. However, a service can be covered and you will still receive a bill if your insurance plan includes out-of-pocket expenses such as deductibles, copays, or coinsurances. Contact our billing staff if you have questions, so they can help you understand what's on your bill.
There are some services that are considered not medically necessary or cosmetic in nature. Your provider will tell you at your visit if a service is known to be not medically necessary or cosmetic and what your out-of-pocket charge will be if you decide to have that service performed. Our staff cannot tell what your diagnoses or services will be ahead of time, as this requires the evaluation of your provider. We can share standard pricing for many services that are considered cosmetic and this may be a helpful reference prior to your visit. However, the final cost of medically unnecessary/cosmetic procedures is entirely dependent upon your visit with your provider.
Frequently Asked Questions (FAQs)
An Important Note Regarding Laboratory Services
If a growth or lesion is removed or a specimen is collected during your visit, you will incur additional costs for laboratory services to process and diagnose your sample, either by our in-house laboratory or an outside laboratory facility. Depending on the complexity of diagnosing the specimen, there may be additional charges. Other terms that may be utilized to describe these procedures include, but are not limited to: biopsy, shave, excise/excision, punch, culture, scraping, or clipping.