Thank you for trusting Bravia Dermatology for your skincare needs. Bravia Dermatology is forever committed to the delivery of world class dermatologic skin care.
Bravia Dermatology will help work with you to fulfill your financial responsibilities. Since we file primary, secondary and tertiary insurance claims for you, it is extremely important that you accurately provide us with your insurance information when scheduling your appointment. We will copy your identification and insurance cards on the date of your visit. If we are unable to verify your insurance by the time of your appointment, you will be considered “SELF PAY”. Please understand that it is YOU the patient, who has a contract with your insurance carrier and you will need to help us work with your insurance carrier throughout the reimbursement process. As the patient, you are responsible for any unpaid balance not contractually offered by your insurance.
Please note that our electronic insurance eligibility checks simply help to verify that your insurance is active, and helps to verify your copays and remaining deductibles. Eligibility checks DO NOT confirm that we are “In-Network” with your insurance carrier, and a successful electronic check is not a guarantee that your insurance policy is active on your date of service. Additionally, insurance carriers have multiple plan types, and we cannot guarantee that we are in network with every plan. Please check with your insurance carrier (usually their website) to verify we are in network with your particular plan. Out of network charges are ultimately the patient's responsibility.
Medicare: Bravia is a participating Medicare provider, accepting assignment for Medicare Part B (Physician Services) claims. The patient is responsible for their Medicare co-insurance, deductibles and any services that are not covered by Medicare.
Medicaid: Bravia Dermatology is committed to skin cancer, and only accepts Medicaid patients on a case-by-case basis for biopsy proven skin cancers, through consultation with your primary care provider (PCP) or referring dermatologist and receipt of a prior authorization approval from your Medicaid plan
Managed Care Plans: In order to see a specialist, some insurance plans require a referral from the primary care provider (PCP) or a precertification before the treatment can be rendered. It is the patient’s responsibility to ensure we have this referral or precertification PRIOR to the visit. If we do not receive the necessary referral or pre-certification, the patient will be responsible for payment or will need to reschedule their appointment.
Commercial Plans: Bravia Dermatology has established fees that are usual and customary for healthcare services in our area. Every insurance carrier has their own fee schedule; however the patient is responsible for payment regardless of the insurance carrier’s arbitrary determination of rates. Here is a link to each insurance carrier for which we are contracted, together with information on how to contact your representative to confirm network status. Since insurance carriers have multiple different plans, the patient is responsible for verifying that Bravia Dermatology is considered “in network” under their particular insurance plan.
Third Party Administrators: Bravia Dermatology, from time to time, contracts with certain third-party administrators. Some examples of TPAs include “MultiPlan” and “PMCS”. These TPAs may have contracts with insurance carriers that Bravia Dermatology is not otherwise under contract with (look for their logo on your insurance card). If your carrier provides out-of-network coverage (i.e. is not an HMO) and the TPA is contracted with your carrier, your carrier MAY process your claim through the TPA as “In Network”. Whether or not a carrier ultimately processes your claim as in-network is outside of our control and the patient remains responsible for confirm whether or not their visit will be “in network” under their insurance coverage.
Non-Covered Services: Some services we provide may be deemed not medically necessary by your insurance carrier or not a covered benefit by your specific policy, therefore, not paid by your insurance. Many cosmetic procedures we provide are not covered by insurance. The patient is responsible for the payment at the time of service, for all services not covered by insurance.
Laboratory Services: Some services, such as biopsies or surgery, require specimens to be sent to a laboratory for processing. The patient may receive a separate bill from the laboratory. The patient is responsible for payment for laboratory services not covered by insurance.
Self Pay: Patients who do not have insurance coverage are considered to be “Self Pay”. Self Pay patients will be required to make payment arrangements prior to services being rendered.
Copay is due at Check-in. If a patient fails to pay their copay at Check-In, the patient will incur a $10 late fee in addition to their copay. We use multiple computer systems that connect with your insurance carrier(s) to determine your copay, remaining deductible, coinsurance, etc. In the event of conflict between a patient’s insurance card and what is showing on our various computer systems, Bravia Dermatology will rely on the information provided in our computer systems.
Deductible/Coinsurance Due at Appointment:
The increasing use plans of higher deductibles and coinsurance by insurance carriers and correlating increased need for multiple tiers of insurance (primary, secondary, tertiary), healthcare providers are being forced to collect these amounts at the date of service. Accordingly, Bravia Dermatology will review your copays, remaining deductibles and coinsurance to estimate the amount of your claim your insurance carrier(s) will assign to your deductible/coinsurance responsibility. This amount will be collected at checkout. As this is only an estimate, after your claims have fully settled, refunds will be issued for overpayments and involves for remaining balances. We use multiple computer systems that connect with your insurance carrier(s) to determine your copay, remaining deductible, coinsurance, etc. In the event of conflict between a patient’s insurance card and what is showing on our various computer systems, Bravia Dermatology will rely on the information provided in our computer systems.
Forms of Payments Accepted:
In addition to cash, check and debit cards, Bravia Dermatology also accepts Visa, Mastercard, Discover, American Express, Apple Pay, Google Pay, Square and CareCredit. For more information on CareCredit, visit www.carecredit.com. Visit www.braviaderm.com/pay to make an online payment.
Payment Plans: Bravia Dermatology does not itself offer financing for patient copays, coinsurance, remaining deductibles, retail, or cosmetic procedures. Bravia Dermatology does accept CareCredit (www.carecredit.com). We accept various CareCredit credit card promotional offers including “No Interest” if paid in full within for six (6) months*, and 24/36 fixed monthly payments at a reduced APR.** The promotional offers we accept are subject to change. Please inquire for more details on current offers.
* Subject to credit approval; Qualifying purchase of $200 is required. Get details.
** Subject to credit approval; Qualifying purchase of $1000 is required. Minimum monthly payments are required. Get details.
Please visit the CareCredit website for more details or to review their terms and conditions.
Credit Card On File: For patients who have paid with a credit card, balances under $50 that remain after we receive your Explanation of Benefits / Electronic Remittance Advice from your insurance company may be run on your Credit Card On File without calling or notification. For larger balances, a statement may be sent or we will call for verbal authorization.
Payments made over the phone will incur the following convenience fee.
Charged Amount (Phone Payment)
Convenience Fee (Phone Payment)
$0.00 to $100.00
$100.01 to $300.00
$300.01 to $500.00
$500.01 to $1000.00
$1000.01 and up
Bravia Dermatology reserves the right to charge (i) a $5.00 monthly statement fee for each account delinquent for 60 days or more (ii) monthly interest at the rate equal to the lesser of 1% per month or the maximum amount permitted by law.
Should it become necessary, Bravia Dermatology may send its delinquent accounts to a collections agency. The patient is responsible for any and all fees/expenses associated with the collection efforts on their account, including, without limitation, reasonable attorneys’ fees, legal and other court costs, collections charges, fees and expenses and interest.
Due to the preparation costs associated with each appointment, Bravia Dermatology reserves the right to charge a cancellation fee for any no-show or failure to cancel at least 1 business day (24 business hours) in advance of a medical or surgical appointment. Cosmetic and laser procedures require at least 4 business days notice to cancel, as certain supplies or medications that expire may need to be opened and prepared several days in advance of your scheduled procedure. Additionally, some products and equipment are special ordered and may expire or may not be available on another day, so deposits left for cosmetic procedures may be forfeited. For more information, please review our Cancellation Policy.
Due to the costs associated with to collection and transmission of medical records, Bravia Dermatology reserves the right to charge a medical records fee under limited circumstances.
Per HIPAA guidelines, copies of medical records must be requested in writing. To ensure your privacy, a form for release of medical information must be completed prior to complying with records request. Please allow Bravia Dermatology five (5) business days to fulfill requests (our staff makes every efforts to respond as quickly as possible). We reserve the right to charge the following administration fees:
**Records Request by Patient or Patient’s Personal Representative:
**Request by Someone Other Than Patient or Patient’s Personal Representative:
On occasion, patients may request Bravia Dermatology to complete certain forms/letters that may be required to assist you with your healthcare needs. Our staff will be happy to help complete these forms and write letters as necessary, upon your request. Be aware that this can be a labor intensive and time-consuming process, so please allow 7-10 days for completion of requested forms/letters. Bravia Dermatology staff is able to commence work upon receipt the administration fee of $25 for the first 2 pages, plus $5 for each page thereafter.
Letter of Medical Necessity; Appeal Letters:
On occasion, patients may request Bravia Dermatology to complete letter of medical necessity or prepare appeal letters. Our staff will be happy to help write letters of medical necessity and appeal letters, upon your request. Be aware that this can be a labor intensive and time-consuming process, so please allow 7-10 days for completion of requested letters. Bravia Dermatology staff is able to commence work upon receipt the administration fee $25 for first two pages, $15 for each additional page.
Prior authorizations are often involve a labor-intensive, time consuming process. Bravia Dermatology will assist its patients with the prior authorization process, however, it reserves the right to charge fees under following circumstances:
Returned Checks/Reversed Payments:
Returned check fee is $35; Credit card charge reversal fee is $35. Patient agrees to reimburse Bravia Dermatology for all fees and expenses incurred in connection with Bravia's past due collection efforts with respect to Patient's account (including, without limitation, legal and collections fees).
Request an Appointment
Bravia Dermatology is committed to excellent care for our patients. We offer comprehensive medical, surgical, and cosmetic dermatology care.
For your convenience, you may submit the request appointment form, and a member of our staff will reply shortly to schedule your consultation. We will do our best to accomodate your appointment preferences. We accept Medicare and most commercial insurance plans.
If you are experiencing an urgent issue, please do not contact us through our website. Call our office directly at 419.948.DERM (3376)