Billing & Insurance FAQ

At Gemini Dermatology, we understand that insurance and billing can be complex. Here are some answers to common questions to help you navigate the process.

WHAT IS A REFERRAL OR PRIOR AUTHORIZATION, AND HOW DOES IT IMPACT MY CARE?

A referral is a request from your primary care physician to see a specialist, like a dermatologist, for a specific concern or treatment. A prior authorization is a request from your insurance company to confirm coverage for a particular procedure, medication, or service. Both are designed to ensure that you receive the appropriate care and that your insurance plan covers the costs. However, please note that insurance plans vary, and coverage is not guaranteed even with a valid referral and prior authorization. Our team will be happy to guide you through the process and obtain any necessary referrals or authorizations to ensure a smooth and seamless experience.

WHAT IS A DEDUCTIBLE, COINSURANCE OR COPAY?

At Gemini Dermatology, we want to help you understand your insurance benefits. A copay is a fixed amount you pay for each visit, usually due at the time of treatment. Note that specialist copays, like those for dermatology services, may be higher than those for primary care visits, which can be as low as $0 in some cases, depending on your insurance plan. However, procedures and treatments are typically separate from copays and are subject to precontracted rates between your insurance company (payor), our practice (provider), and you (patient). These rates can impact your out-of-pocket costs through deductibles and coinsurance. A deductible is the amount you pay out-of-pocket before your insurance coverage kicks in, and coinsurance is a percentage of the treatment cost that you pay after meeting your deductible. Most plans also have a maximum out-of-pocket (MOOP) limit, after which most or all services are covered, but this varies depending on your specific plan. While copays cover visits, procedures may fall outside of this and require additional payments. Once you reach your MOOP limit, you may have fewer or no out-of-pocket costs for services. Don't let insurance jargon confuse you! Our team is here to help you understand your benefits and make the most of your coverage.

DOES MY INSURANCE PLAN COVER SKIN CANCER SCREENING AS A PREVENTIVE CARE BENEFIT?  

Please note that skin cancer screenings are not typically covered as a preventive service, which means you may be responsible for copays, deductibles, and coinsurance. We encourage you to review your insurance plan details to understand your financial responsibilities for these screenings

WHY AM I RECEIVING SEPARATE BILLS FOR MY BIOPSY OR LABORATORY TESTS?

If you've received a separate bill for pathology or laboratory services, it's likely because these services are provided by a specialized laboratory or pathology group (e.g., Cockerell Dermatopathology, Quest Diagnostics, Labcorp, etc.), which may not be included in your dermatology office's fees. This is a common practice in healthcare, and the extra bill is for the expert analysis and interpretation of your biopsy or lab tests.

I'VE BEEN COMING TO THIS PRACTICE FOR YEARS, BUT MY LATEST APPOINTMENT WAS CHARGED AS A NEW PATIENT VISIT. DID SOMETHING CHANGE IN YOUR BILLING SYSTEM OR WAS THIS AN ERROR?

We appreciate your long-standing trust in our practice! Sometimes, insurance plans require us to bill a visit as 'new' if you haven't been seen in a certain time frame (usually 3-5 years), even if you've been a established patient with us. Our team will be happy to review your account and correct any errors to ensure you're billed appropriately.

WHAT'S THE BEST WAY TO CONFIRM MY INSURANCE COVERAGE FOR MY UPCOMING VISIT OR PROCEDURE? HOW CAN I GET AN ESTIMATE OF THE COSTS INVOLVED?

Insurance coverage and benefits vary by provider, so please consult your member handbook or contact your insurance company directly for specific questions about your coverage. Keep in mind that deductibles, coinsurance, and copays will apply to covered services. If you'd like an estimate of your costs, we can provide a Good Faith Estimate upon request. Please note that this estimate is an approximation and not a guarantee of payment. Your insurance company will process the claim and send you an Explanation of Benefits (EOB) detailing the payment responsibilities, which may include costs covered by the insurance company, the policyholder (you), or a combination of both. Always verify your specific benefits with your insurance provider for the most accurate information.