OFFICE / FINANCIAL POLICY 

Welcome, and thank you for choosing A & G Dermatology for your dermatologic care. We are committed to providing you with the highest quality medical care possible in a cost effective manner. Our professional fees have been determined through careful consideration in addition to being reasonable and customary within our medical specialty and geographical area. We are pleased to discuss with you any questions you may have concerning a bill.

 

We are a Medicare-friendly office as well as approved providers with many private insurance plans. Please bare in mind, however, due to the vast scope of insurance coverage, it is ultimately the patients’ responsibility to verify current coverage within their specific insurance plan, and that the doctor is an approved provider within that plan. Payment for elective/cosmetic procedures (out-of-pocket), as well as insurance co-payments, are due at the time services are rendered. If you are being referred to us from another physician, please inquire as to whether authorization from your insurance carrier is required prior to your visit.   

 

 

For cosmetic consultation appointments there is an appointment fee due. This fee will be applied towards the cost of that procedure should you and the doctor decide to proceed with the treatment at our office as discussed. Consultation fees cannot be submitted to medical insurance for reimbursement.    

 

 

Payment in full is due at the time services are rendered. As a courtesy to our patients, we accept cash, personal check, money order, Debit, Visa, MasterCard, Discover, and American Express. We also provide our patients the ability to pay for their accounts over the phone: (773) 237-7546. 

 

 

Please call our office if you have any billing or insurance questions.

 

Office Hours / Contact Us
 

Monday: 9:00 am - 5:00 pm

Tuesday: 9:00 am - 4:15 pm

Wednesday: 9:30 am - 5:30 pm

Thursday: 9:00 am -5:00 pm

 

  • Fridays**: 9 am - 1 pm 

--no scheduled patients, unless otherwise posted here--

** patient clinic hours  9 am - 1 pm on:

 

Friday, December 6, 2019

Friday, December 13, 2019

Holiday hours December 24 : 9 am- 1 pm

(closed December 25)

Friday ,December 27, 2019

Holiday hours  December 31: 9 am - 1 pm

(closed New Years' Day)

Friday, February 28, 2020

Friday, March 6, 2020

Friday, March 27, 2020

Friday, April 3, 2020

Friday, April 24, 2020

Friday, May 8, 2020

more to follow......

DECEMBER 2

 

Saturday / Sunday : closed

 

 

 

After Hours / Emergencies
 

If you are experiencing a medical emergency, call 911 now.

If the patient (must be a established patient in our practice) is experiencing an urgent or emergent situation regarding their skin condition, after office hours, the doctor on-call may be reached by calling (773) 237-6666 or (773) 237-7546, and follow the prompts.

 

 

Appointments
 

Please bring your most current health insurance card(s), drivers license / photo I.D., and a method of payment to each appointment.

 

Please arrive for your appointment at least 15 minutes early to allow for registration into our electronic medical record system [EMR]. If you arrive more than 15 minutes late for your appointment, you may be asked to reschedule your appointment.

 

It is your responsibility to verify that the physician is currently under contract with your insurance plan and that you have obtained all necessary referrals BEFORE your scheduled appointment. (Failure to confirm this may result in your responsibility for any and all charges.)

 

Please inform the receptionist of any demographic changes (phone number, address, insurance information, etc.). Failure to notify us immediately of changes in demographic information, financial status, and/or insurance coverage may result in you being responsible for any services not covered by your insurance carrier.

 

All co-pays are due at the time of service and all balances are due prior to any further service provided by our office.

 

 

Cosmetic/Elective Procedures

 

 

By definition, these procedures are not covered by insurance companies; and this office does not submit claims on their behalf. Payment in full is required on the day of the scheduled procedure.

 

Security / Privacy

 

We comply with the federal standards regarding privacy and security of your personal health information. (HIPAA)

Lab/Hospital Charges

 

Any fees incurred for service(s) provided by a lab or hospital deemed necessary for your skin care, between you and that lab or hospital. Any dispute with that lab or hospital should be handled with that lab or hospital and is not the responsibility of our practice.

 

It is your responsibility to know which procedures your insurance will and will not cover at these facilities and to request an Explanation of Benefits (EOB) from your insurance carrier.

 

Collections & Outstanding Balances

 

Our medical billing department reserves the right to add a $10  statement late fee on any account that has an unpaid balance. Any outstanding balance after 60 days of the date of service may be referred to an outside collection agency.

 

Patients with unpaid delinquent accounts or accounts which have been sent to collections may be discharged from our practice. 

 

Payment Plans & Refunds

 

Our office will be happy to work with you in order to pay any balance due to our practice. Please contact our billing department to discuss a payment plan.

 

You can make payments over the phone or mail payments to our office. Allow 5 mail days prior to each due date for each payment to be received by our practice.

 

Refunds are issued only to the appropriate party. Patient refunds will not be processed until all active or past due charges are paid in full.

Insurance: In Network vs. Out of Network
 

 

Your insurance coverage and benefits are a contract between you and your insurance company and therefore all disputes must be handled between you and your insurance company.

 

Please note  that insurance is considered a method of reimbursing the patient for fees paid to the doctor and is not a substitute for payment.

 

Some companies pay fixed allowances for certain procedures, and others pay a percentage of the charge. We are contracted with multiple insurers to accept assignment of benefits. If you have insurance coverage under a plan with which we do not have a contract, you will be treated as a self -pay patient.

 

We are required to file with your primary insurance carrier only. As a courtesy to our patients, we will file a claim with your secondary insurance. The medical insurance you supply to our office must be accurate and up-to-date.

 

Methods of Payment

 

As a courtesy to our patients, we accept cash, check, money order, Debit, Visa, MasterCard, Discover, or American Express. (An additional option would be to sign our Patient Pay-Easy Consent form in order to keep a credit card number on file to be used for any unpaid balances.)

 

Co-pays and co-insurance amounts, deductibles, and all non-covered items and charges are the insured/patient’s financial responsibility and are due during the check-in process. Failure to produce payment at check-in may result in your appointment being rescheduled.

 

Any amount not covered by the insured/patient’s insurance is due within 30 days of the time of service. Any outstanding balance may incur a $10  statement late fee in addition to the initial balance.

 

Failure to pay balances may result in discharge from the practice.There will be a fee of $35 for any returned checks to our office.

Missed Appointments

If you must cancel your scheduled appointment,  we greatly appreciate notification as soon as reasonably possible.  Patients who repeatedly fail to show, or fail to cancel an appointment, may be discharged from our practice.

 
Medicare Patients

Please make sure you have a full understanding of your benefits and what might be your responsibility if not covered by your insurance plan. Medicare requires that we provide patients with a written notification whenever it is likely that you will be responsible for a bill.

 
Minor Patients

The parent(s) or guardian(s) accompanying a minor {any patient under the age of 18} are responsible for providing current insurance information for the minor as well as the payment in full for services provided.

 

Parent(s) or guardian(s) must have an Authorization for Medical Treatment form signed each time a minor arrives unaccompanied for an appointment.

 

In compliance with HIPAA regulations, we are unable to discuss any details of services rendered or to produce an itemized bill for any parties that are not the patient or parent/guardian unless otherwise documented.

 

Both parents/legal guardian(s) are responsible for payment for services rendered to the minor patient. A copy of this financial policy and all statements can be provided to each parent if living in separate residences, upon request.

Medical Records/Confidentiality

 

Your medical records are held in the strictest confidence. A & G Dermatology makes every effort to be fully HIPAA compliant. A summarized copy of the HIPAA documentation is available in our office.
 
If you request a copy of your records to be sent to another physician or to yourself, a written authorization will be required. A processing fee and additional costs may apply. Only the records requested will be supplied/ forwarded. 
Call today and schedule an appointment

A & G Dermatology Associates

1733 N Harlem Avenue

Chicago, IL 60707

773.237.7546 (SKIN)

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