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Jean Holland Dermatology

Jean M. Holland, MD, FAAD

REIMBURSEMENT RULES 

I can take care of anyone.  Patients pay for a short, regular, or extended appointment -- their choice -- when they come in.

Insurance companies may reimburse you for your appointment at Holland Dermatology if they would have covered the visit at a participating office.


If you want to file for reimbursement, you usually need to get a special receipt from us that details all applicable codes and modifiers.  Yes, we have already given you a receipt, but it doesn't include codes, because looking them up is extra, meaningless work.  We left insurance-based medicine to get away from that nonsense.   So, there is a $5.00 charge for coding the receipt.  The coding charge is added to the office visit cost, so if the office visit is reimbursed, you may get your $5 back as well.


IF YOU HAVE MEDICARE:
You sign the contract that CMS (Center for Medicare Services) requires, stating that you understand I am a non-participating doctor.

 If you have no secondary insurance, or if the secondary is Tri-Care or Medicaid, that is the end of it.  You cannot get any reimbursement.

 If you have a secondary insurance such as Blue Cross, Aetna, UHC, etc.:


Plans such as Medicare Advantage fold Medicare into a commercial insurance plan, and will not reimburse at all.

If you have a true MediGap policy, contact your secondary insurance company to see if they will reimburse an out-of-network doctor.  If they will, request the form they require.  

Send our detailed receipt to your insurer along with any form they require.  Remember, you cannot submit to Medicare for reimbursement, ONLY to your secondary!


IF YOU HAVE COMMERCIAL INSURANCE (Blue Cross, etc.):
We are treated as an out-of-network provider.   Contact your insurance company to see if they will reimburse, and if they have a special form to use when filing for reimbursement.  You can then pay for a  coded receipt from us.

Send the receipt and the form (if there is one) to your insurer.


So far, our patients with Blue Cross plans that cover out of network care have been reimbursed.  UHC and Aetna have not been as good.


IF YOU HAVE A HUGE DEDUCTIBLE
Keep your receipt.  Insurance companies have different policies regarding payments to non-participating doctors.  Some allow those payments to count toward the deductible, and some don’t.  Submit only if you think you may reach your deductible.


IF YOU HAVE A HEALTH SAVINGS ACCOUNT (HSA) OR FLEX ACCOUNT
You may use these accounts at Holland Dermatology without restriction.  You may need a coded receipt to prove the service was valid medical care.