West Houston Dermatology

Welcome to WHDERM - West Houston Dermatology

PAYMENT DUE AT TIME OF SERVICE:

All fees, co-pays, deductibles and self pay charges are due in full at time of service.  As a courtesy, West Houston Dermatology will verify insurance benefits prior to appointments, however it is the patient’s responsibility to know their insurance benefits.  Insurance coverage is not a guarantee of payment.  If there is any uncertainty about coverage, we will be happy to provide you with an estimate of our fees before treatment begins, however, the patient will be responsible for any charges not covered by insurance.

IMPORTANT NOTICE:  “COSMETIC PROCEDURES OR THOSE DEEMED MEDICALLY UNNECESSARY”

With the recent changes in the health care industry, more and more insurance companies are instituting restrictions on ‘covered procedures’.  Our office is aware of many procedures that are considered “not medically necessary” or “cosmetic” and will make an attempt to alert you of these procedures.  If you and your physician decide to continue with a procedure that falls into this category, we require payment in full at the time of service.  There is no reduction in fees for HMO, PPO, or Medicare patients for these procedures.  If you have any questions or concerns about what is considered “not medically necessary” or “cosmetic”, please do not hesitate to ask your physician or a member of our staff.  We will be happy to assist you with any of your questions or concerns.  Many of our cosmetic appointments will require a deposit at the time of scheduling.  If you are a ‘no-show’ at the appointment or cancel on the same day without notice, we will keep the deposit.  Please try to call at least 48 hours in advance if you need to reschedule or cancel an appointment.

FINANCIAL RESPONSIBILITY:

Again, while our staff makes every effort to verify insurance benefits, please be aware that it is ultimately the patient or responsible party’s responsibility to ensure that their own condition/treatment is covered.  If after filing insurance claims, it is determined that there is an outstanding balance, the patient or responsible party will be billed and payment will be  due upon receipt.

CANCELLATIONS AND MISSED APPOINTMENTS:

We ask that you make every effort to keep your appointment. If you must cancel or reschedule, we require at least a 24 hour notice so that proper scheduling can be maintained.  Effective August 1, 2012, our policy is to assess a fee of $50 for all general appointments, and $100.00 for all cosmetic appointments that are missed or cancelled without a 24 hour notice. We thank you for your understanding.

LABORATORY AND PATHOLOGY CHARGES:

Certain conditions will require labs, cultures and/or pathology testing.  Please note these are a separate service which may result in outside billing based on your insurance coverage.  You are responsible for any charges not covered by your health insurance.  If you have any questions regarding these tests, please ask a member of our staff prior to the service.

DISCLOSURE OF FACILITY WITH AFFILIATION AND/OR REMUNERATION:

In compliance with Section 102.006 of the Texas Occupations Code, my attending provider(s) and /or West Houston Dermatology, PA (WHD) have disclosed to me that in the event procedures are performed that require the removal of pathology specimens; these specimens must be sent to a third party pathology laboratory for preparation. This third party dermatopathology laboratory (ADG or DLCS) may interpret the results, but some specimens may be returned to WHD to be interpreted by Dr Mahoney. In some cases, WHD may receive direct or indirect remuneration for such referrals.

RETURNED CHECKS:

Our office will assign returned checks to the District Attorney’s office for collection.  We charge a $75.00 service charge on all returned checks.  If any fees are assessed to our office during the collection process, they will be added to your account balance.

COLLECTION EFFORTS:

We require payment in full at the time services are rendered.  Should your account show a balance for any reason, we will make every effort to work with you to make payment arrangements.  If all of these efforts do not bring about resolution of the account, the account will be turned over to a collection agency.  Any fees assessed to our office by the collection agency will be passed on to your account.

I HAVE READ AND UNDERSTAND THE WEST HOUSTON DERMATOLOGY FINANCIAL POLICY AND AGREE TO COMPLY WITH THE FINANCIAL POLICIES OF WEST HOUSTON DERMATOLOGY.

Download the Financial Policies (.pdf)