Understanding the Billing Process

What is a copay, co-insurance or deductible?
Please access our health care terminology reference online for assistance in understanding common terms or phrases.

How do I know if my service will be covered?
Contact your insurance plan to determine your benefits. Please reference our listing of common plans we participate with including our Tax ID # that you can provide to your insurance plan to determine provider participation status and benefit level for the individual provider whom you are scheduled with. It is important to supply the individual provider information to your insurance carrier to confirm there are not benefit variations or exclusions. We also list an area of common procedure codes that you can inquire on to your insurance company for coverage and/or out of pocket expense.

Depending on your insurance plan, a referral or authorization is necessary for some services prior to the appointment. Your primary care physician’s involvement may be required.

I don’t have health insurance. What are my options?
We maintain a fee schedule that we can quote an estimation of services. We accept Visa, Mastercard, Discover and American Express. Financing options are available via third party vendors such as Care Credit.

What is an ABN and why do I need to sign one?
An ABN is an Advanced Beneficiary Notice, also known as a waiver of liability signed by the Medicare patient prior to receiving service. The reason you are being asked to sign an ABN is that we believe, based on the information we received from your provider, that Medicare will deny payment for your service. Medicare requires that we notify you in writing whenever it is likely that you will have to pay the bill.

Why do you think that Medicare will not pay for this service?
Medicare only pays for services that it considers to be medically necessary only under certain circumstances, depending on the patient’s diagnosis.

Does my insurance cover preventive services?
The Affordable Care Act requires that group and individual health insurance policies include a “no cost” benefit for “preventive services,” which essentially include services that have been recommended with an “A” or “B” rating in the Guide to Clinical Preventive Services (the “Guidelines”) published by the U.S. Preventive Services Task Force (“USPSTF”). Skin cancer screening is not recommended in the USPSTF’s Guidelines. Because the guidelines do not recommend skin cancer screening as a “preventive service,” dermatologists cannot submit claims as preventive visits or wellness exams, even if the screening is for malignant neoplasms.

Our providers are happy to see you for an exam; however, because skin screenings are not recommended in the preventive services guidelines, we are unable to submit claims for preventive skin screenings to your insurance as a “no cost” benefit under the Affordable Care Act.

Why am I being charged two copays?
Water's Edge Dermatology offers comprehensive services and plans of treatment that may include care from multiple providers (Physicians, Physician Assistant or Nurse Practitioners). Some insurance policies may dictate that an additional copay be collected or higher out of pocket costs than anticipated, especially in cases were multiple providers are seen on the same date of service. A separate statement will be mailed to you, for any additional responsibilities not collected at time of service.

Should you have any questions regarding the specific terms of your selected policy or any additional fees determined to be “member responsibility,” please contact the Member Service line, set in place by your Health Insurance Carrier. This telephone number is often located on the back of your health insurance card.

Help me understand pathology charges.

Water's Edge Dermatology maintains an in-house laboratory. Additional pathology charges may be incurred in the event specialized testing is required to make a definitive diagnosis. There are times that our pathologist will determine that it is necessary to apply stains to your tissue sample in order to diagnose your condition. The type of stain and number of stains cannot be determined in advance. In the event that special stains are required, you will receive a statement for these services in addition to today’s services.

When pathology, cultures, or other tests are sent to an outside laboratory, these vendors will bill you separately. Outside labs such as Quest and LabCorp are often required by some insurance plans. Should your insurance policy require the use of a particular lab, please notify us at check in. If your policy does require the use of an outside lab, we will still collect for services rendered in our office at the time of service. The tissue will then be sent to the laboratory required by your insurance for processing and testing, and you will receive a separate statement from the outside lab for any balance owed for those services.

How do I make a payment?
Credit card payments can be taken over the phone during our office hours, Monday through Friday from 8:00am – 4:30pm, at our toll-free number 1-877-900-3223.

You can access your patient portal anytime and pay online. Web browsers currently supported include:

Google Chrome – 30 and higher
Mozilla Firefox – 40 and higher
MS Internet Explorer – 11 and higher
MS Edge – 13 and higher
Opera – 35 and higher
Apple Safari – 9 and higher

To avoid a delay in payment or possibly being charged for additional fees, please do not use a third party company to make payments toward an account balance.

Will you submit to my secondary or supplemental insurance?
If you have secondary or supplemental insurance, please provide us with your insurance card and we will submit any balance to the plan. If your secondary or supplemental insurance does not cover the balance, or if you do not have secondary or supplemental insurance, the balance will be billed to you.

I am unable to pay my balance in full immediately. Can I set up a payment plan?
Please reach out to our Patient Account team during our office hours, Monday through Friday from 8:00am – 4:30pm, at our toll-free number 1-877-900-3223.

I paid an estimation of costs at the time of my visit. Why am I receiving an additional bill?
Quotes provided at the time of service are an estimation. We must wait for your insurance company to process your claims to determine a final bill.

Why was my last payment divided and applied to the bill in two separate places?
Your payment is posted to the oldest balance first unless you have a balance on a payment plan.

Why is my payment being sent to an address out of state?
To provide quality customer service to our patients we partnered with a third-party vendor that posts our insurance and patient patients in Atlanta, GA.

My EOB states services performed by Naples Center for Dermatology.
Water's Edge Dermatology is a DBA of Naples Center for Dermatology and Cosmetic Surgery.

Whom should I contact regarding questions on my billing statement?
If you need assistance, please reach out to a member of our Patient Account team during our office hours, Monday through Friday from 8:00am – 4:30pm, at our toll-free number 1-877-900-3223.

How do I access my medical records?
Medical records can be access via our online electronic health record portal. If a full record is needed, please complete the Authorization to Release Medical Information document and submit to your local medical office.