CANCELLATION / NO SHOW POLICY
We understand that your schedule may change and that emergencies arise. If you are unable to keep your appointment, we ask that you kindly provide us with 24-hour notice.
If the patient fails to notify the office or fails to appear 3 or more times, the patient may be assessed a fee of $50 for regularly scheduled visits. There will be a $100 fee for any surgery or patch testing appointments that are not canceled within 24 hours or if the patient fails to appear
As a courtesy, DCSI will submit claims to all insurance carriers. To do this we must have the most current insurance card(s) and other necessary personal information at the time of service. Submitting claims to an insurance company on behalf of the patient does not imply that we are in-network or contracted with that insurance company.
It is the patient’s responsibility to know if DCSI is considered “in network” or a “contracted” provider with their insurance carrier/network. Each patient is responsible for knowing their own insurance coverage including the deductible, co-insurance, copay amount, and the coverage policies for procedures. DCSI displays a list of insurance companies, with whom we are contracted, at the front check-in counter for everyone to review prior to registration. We encourage all patients to review the list each time they arrive for an appointment.
If your health plan requires a referral in order to receive care at our facility it is your responsibility to make sure an appropriate referral has been requested prior to your visit. If you do not obtain a valid referral from your primary care physician, and your health plan does not pay for our services, you will be responsible for payment.
Patients are asked to pay any co-pay and/or deductible amounts at the time of service. If we are not contracted with the patient’s insurance company, the patient will be asked to pay a $35 deposit/co-pay unless their card states another amount. Patients that do not have insurance coverage are considered “self-pay” and will be asked to pay $160.00 at the time of service. For self-pay patients, the $160.00 paid at the time of service will be applied to the office visit. Any additional procedures performed by DCSI during the visit will be billed to the “self-pay” patient and will be due and payable in 90 days from the date of service. For “self-pay” patients, any monies left over from the $160.00 prepayment will be applied to any other procedures billed. If no other procedures are billed and a credit still remains, a refund will be issued to the patient or guarantor.
Patients who have in-network or contracted insurance coverage have 90 days from the time their insurance carrier responds to pay their account balance in full. Self-pay patients have 90 days from the date of service to pay their account balance in full. If DCSI submits a claim to a non-contracted insurance company and there is no response from the carrier, the balance will become the patient’s responsibility 45 days after the date of service. If we are contracted with the patient’s insurance carrier we will take all necessary steps to follow up on the claim. In the event that a patient’s account balance is not paid in full within the 90 days allowed, it will be transferred to our outside collection agency. The patient will become responsible for all collection costs including any fees, attorney fees and court costs.
DCSI will not file any non-covered or cosmetic services to insurance companies. Non-covered and cosmetic services will be considered the patient’s responsibility at the time of service. Patients are encouraged to contact their insurance carrier regarding their benefits prior to having services or procedures done. In the event that a patient’s insurance carrier denies a procedure as non-covered, it will become their responsibility.