Patient Insurance

Common Questions about Your Financial Obligations

For procedures covered by insurance, we accept Medicare, Preferred Provider Organization (PPO), Point of Service (POS), Private and Group Plans. Patients are responsible for any co-payments, coinsurance or deductible amounts.

Co-pay/co-payment – the amount an insured individual must pay toward the cost of a particular benefit. For example, a plan might require a $20 co-pay for each doctor’s office visit.

Co-insurance – the percentage of covered expenses an insured individual shares with the carrier (i.e., for an 80/20 plan, the health plan member’s co-insurance is 20%). If applicable, co-insurance applies after the insured pays the deductible and is only required up to the plan’s stop loss amount.

Stop-loss – the dollar amount of claims filed for eligible expenses at which the insurance begins to pay at 100% per insured individual. Stop-loss is reached when an insured individual has paid the deductible and reached the out-of-pocket maximum amount of co-insurance.

Deductible – the dollar amount an insured individual must pay for covered expenses during a calendar year before the plan begins paying co-insurance benefits.

At this time, we do not accept HMO insurance plans. You can also obtain our tax ID when you come in to determine whether your provider authorizes treatment through our Center for your condition.

Will you bill my insurance company for my procedure?

Yes. Orange County Dermatology is contracted with most health plans; PPO, POS, private and group. When you sign-in and register, we will copy your health insurance ID card as a reference for your coverage and the pending claim. In addition, your insurance eligibility will be verified.

Claim – a formal request made by an insured person for the benefits provided by a policy.

ID card/identification card – card given to insured individuals that advise medical providers that a patient is covered by a particular health insurance plan.

Does Orange Coast Dermatology accept payment from Medicare?

Yes. We will submit your visit and/or procedures to Medicare. Again, you must pay the Medicare deductible and/or co-insurance. If you have Medicare supplemental insurance coverage, Orange Coast Dermatology will bill your supplemental insurance carrier for your deductible and/or co-insurance.

Will my insurance carrier cover my treatment?

Insurance benefits vary between health plans. To ensure a particular treatment and/or service will be covered by your insurance carrier, we strongly recommend contacting your insurance carrier to find out about your coverage so there is no surprise after treatment has been completed. Should a particular treatment and/or service be denied, you will be personally responsible for payment of all fees.

Will you bill me for my deductible and/or coinsurance?

Yes. Orange Coast Dermatology will bill you for any deductible and/or co-insurance amounts due after your claim has been processed by your insurance carrier. An Explanation of Benefits (EOB) will be mailed to us stating all services covered. In addition, a copy will be mailed to you for your records.