Bravia Dermatology Financial Policy  (updated 1/2022)

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 or you do not have a credit card on file, 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.

Eligibility Check vs. “In Network”

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.

Types of Insurance Plans/Services:

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 does NOT accept primary or secondary Medicaid plans. Because Bravia Dermatology is committed to helping patients with skin cancer, we will accept 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 or do not have a credit card on file are considered to be “Self Pay”.  Self Pay patients will be required to make payment arrangements prior to services being rendered.

Additional Financial Terms

Payment
Payment is due on the date of service. Patients are required to maintain a credit card on file with Bravia Dermatology. Those who maintain a valid credit card on file with Bravia Dermatology will only be responsible for their copay and estimated deductible and coinsurance for services rendered on the date of service. Those who refuse must pay for their services, in full, on the date of service.

Copay:
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 invoices 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. Those who fail to pay the copay or estimated deductible/co-insurance at checkin may result in a $10 late fee.

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. Using a credit card allows for quicker refunds in the event of an overpayment.

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.   

Telephone Payments:
Payments made over the phone will incur the following convenience fee.

Statement Fees/Interest:
Bravia Dermatology delivers its statements electronically, through its patient portal or via email. Each patient is expected to provide an email and activate their portal to access their health record, test results, billing information, etc. Those who fail to provide an email address or require a paper statement will incur a $5.00 statement fee. Outstanding balances delinquent for 60 days or more shall accrue interest at the rate equal to the lesser of 1% per month or the maximum amount permitted by law.

In the event a patient has an overpayment, Bravia Dermatology may hold for any upcoming appointment or issue a timely refund. Credit card payments refunds are processed quickly, efficiently and without charge. Bravia Dermatology reserves the right to charge up to $10 per written refund check to account for the administrative expenses incurred therewith. Again, payment via credit card will be refunded without charge.

Collections:
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.

Missed Appointments:
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.

• General Dermatology:  $25 for first missed general dermatology appointment, $50 for each subsequent missed appointment.  After the second missed appointment, a $50 non-refundable payment deposit is required to schedule an additional appointment.
   
• Surgery:  $75 for first missed surgery appointment, $150 for each subsequent missed surgery appointment.  After the second missed surgery appointment, a $150 non-refundable payment deposit is required to schedule an additional surgery appointment.   Please note that if we need to reschedule your appointment due to uncontrolled high blood pressure, anticoagulation levels being too high (INR > 3), or other medical reasons, an office visit is still charged for evaluation and management  of these complicating factors at such time.
   
• Cosmetic Consult:  $150 for each missed cosmetic consult.  Every cosmetic consult requires a $150 deposit at scheduling.
   
• Cosmetic Laser/Procedure:  Deposits, promotions and discounts are non-refundable.  For any missed procedure, the Patient will be responsible for the setup costs and/or the cost of special order products obtained/used in preparation for the procedure.

Medical Records:
Due to the costs associated with the collection and transmission of medical records, Bravia Dermatology reserves the right to charge a medical records fee under limited circumstances.

• Office visit notes are available for FREE on our patient portal.  https://braviaderm.ema.md
   
• Medical records that need to be searched, collated, and faxed or printed incur fees due to the staff time and expenses incurred by Bravia to complete such tasks.
   
• Before making a formal request for copies of medical records, please determine whether or not such information is available on our FREE online patient portal.  

 
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 effort 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:

• $30 for first 10 pages
• $5 for each 10 pages (Pages 11-50)
• $2.50 for each 10 pages thereafter (51+ Pages)
   
• Postage : Actual cost of mailing
• eFax: $0.20 per page

**Request by Someone Other Than Patient or Patient’s Personal Representative:

• Initial Fee of $15.00 for record search (due upfront)
• $12.50 for the first 10 pages
• $5.00 for each 10 pages (Pages 11-50)
• $2.50 for each 10 pages thereafter (51+ Pages)
   
• Postage : Actual cost of mailing
• eFax: $0.20 per page
   

Forms Completion:
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 will collect an administration fee of $25 at the time the form is presented to our office.
 
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 at least 10 business days for completion of requested letters.  Bravia Dermatology will collect an administration fee of $25 at the time of request.
 
Prior Authorizations:
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:

• First electronic Prior Authorization request or substitution - No charge. 
• First non-electronic Prior Authorization request or substitution - $10.
• Each additional correspondence regarding prior authorizations for same condition / drug:  $5 per correspondence, charged to Credit Card On File (required).

Returned Checks/Reversed Payments; Overpayments:
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).  In the event a patient has an overpayment, Bravia may hold for any upcoming appointment or issue a timely refund.  Credit card payments refunds are processed quickly, efficiently and without charge.  Bravia reserves the right to charge up to $10 per written refund check to account for the administrative expenses incurred therewith.  Again, payment via credit card will be refunded without charge.

Return Policy:

• Should you be dissatisfied with your retail product purchase, you may return your unopened retail product, with receipt, for a full refund within 14 days of purchase.
   
• Under extenuating circumstances, and within 14 days of purchase, an opened item with original packaging may be accepted for return or exchange as a one-time exception with manager approval. Opened items that have circumstances deemed eligible for refund are subject to a 20% restocking fee, or with manager discretion a gift card for the original purchase amount may be issued to be used toward the full price purchase of other cosmetic services or products offered by Bravia Dermatology.
   
• Items marked as “Clearance” or “Final” sale/markdown are considered FINAL and no returns will be accepted.
   
• If you experience an unanticipated reaction to one of our retail products, Bravia Dermatology will use reasonable efforts to cause the manufacturer to (i) exchange the product at no charge or (ii) provide a refund.  Returned or exchanged retail products must be in the condition you received them, unopened and in the original box and/or packaging.  Please note that some products like topical retinoids, acids / exfoliators, and fading creams are expected to cause some peeling or irritation, especially when you first start using them. Some acne treatments may cause an initial flare or temporary perception of worsening, but continued use usually will resolve this.   
   
• Because results vary, and can depend on pre-procedure and post-procedure care, we cannot guarantee any particular result. Accordingly, Bravia Dermatology does not grant refunds for any reason for any procedure/service performed.
   

Telemedicine / Virtual Visits:
Patients who schedule telemedicine appointments expressly consent to the use of 3rd party communication tools during the course of their medical consultation.  Communication tools include patient portal, phone, email and live face-to-face video conferencing.  Bravia Dermatology will bill for these services to a patient’s insurance policy carrier consistent with applicable rules and regulations.  Patients remain responsible for the amount their insurance company deems to be patient responsibility, including copays, deductibles and coinsurance.  While Bravia Dermatology utilizes secure communication tools that satisfy HIPAA, PIPEDA, and GDPR, no electronic communication can be guaranteed 100% secure.  By using this service you assume that small risk.