We appreciate your kind consideration of our office policies. Their purpose is to provide consistent quality service to all our patients equally.
Below you will find an overview of our financial policy. For our full financial policy please click here.
The following applies to patients who have medical insurance:
We require you to fill out our financial policy so that we have an agreement for payment in rendering your service. We request that a credit card number be given at your first appointment and periodically updated at the time of expiration. If you elect not to leave a credit card, we require a deposit of $150.00 per visit. This deposit will apply towards your visit once insurance has processed if there is a remaining patient balance. You will be refunded for overpayment on your account, when applicable within 15 days of complete payment.
We bill your insurance company as a direct courtesy to our patients. We work with each patient and their provider to reconcile any payment disputes. There is a limit to the services our billing team can provide due to the high administrative cost involved. We strongly suggest you monitor your account carefully. We ensure our best effort to make this as smooth a process as possible.
Monthly statements consist of a patient balance and insurance balance. When an insurance provider is held accountable for services provided, you are only held liable for what is considered the patient portion. In situations when your insurance provider pays its portion and you have a remaining patient balance, you will receive two billing statement from our office. We ask that you submit this payment within 60 days from the date of our first statement. Your payment will be charged to your credit information on file with our office if you do not pay on time.
You also have the option for automatic bill pay. With this option, you can opt out of receiving statements for any balances remaining on your account after insurance submits payment. Once payment is made, our office will email you a receipt.
When your insurance provider delays or withholds payment for 90 days or longer, both the insurance and patient portions will become your responsibility. Please keep in mind that any reimbursement to us at a later date will be credited to your account and reimbursed to you promptly.
If there has been a change in your contact or insurance information, please contact the billing department at 773.276.6823 or at firstname.lastname@example.org.
HIPAA and Notice of Privacy Practices
We are dedicated to treating your medical information with the utmost care. We urge you to familiarize yourself with our privacy practices to understand your rights as well our office’s obligations regarding your personal health information. Please click here for our comprehensive privacy practices. If you have any questions, please do not hesitate to contact us.
- If you arrive 15 minutes or more after your scheduled appointment time, your appointment may need to be rescheduled or you will have a longer wait before you are seen.
- Appointment times are reserved especially for you. Please be mindful of this if you are unable to keep your appointment. Providing us with a 24 business hour notice will help us make this appointment available to another patient.
- In the event that you no-show or cancel less than 24 business hours prior to your scheduled general dermatology appointment, you will incur a charge of $25.00.
- In the event that you no-show or cancel less than 24 business hours prior to your scheduled aesthetic or laser appointment, you will incur a charge of $50.00.
- In the event that you no-show or cancel less than 24 business hours prior to your scheduled surgical, cosmetic injectable, wellness, or acupuncture appointment you will incur a charge of $100.00.
You will be reminded of these fees at the time of scheduling.