receptionist helping patient

Insurance and Billing

Insurance Information: Your Records

Please note:

Please be sure to bring your current insurance cards and a photo ID with you to each visit. We will need to keep current copies in your records.

We accept most insurance plans. Most insurance plans and managed care payers have policies that require co-payment at the time of service. You will be responsible for payment of all co-pays and any outstanding balances at the time of visit. If you are covered under an HMO or other managed care plan (Point of Service or PPO) there may be specific coverage limitations. If services are not covered under your insurance plan you are responsible for payment. You will be required to pay for such services at the time of the visit.

You need to have the following to verify coverage prior to making your appointment:

  • Current insurance card – make sure you have your current insurance card (from this year)
  • Active plan – make sure your current insurance plan is active and ask what skin care providers are in your network

We will verify eligibility and benefits:

  • Coverage will vary based on the type of service and provider.
  • If you have an HMO, we will need an active referral for dermatology services.

NOTE: We can verify eligibility and some of your benefits. For all benefit information, reach out to your insurance carrier. Ultimately, you, the patient, are responsible for understanding your insurance coverage and for ensuring your services are covered and/or paid.

Lupton Dermatology Accepted Insurances

  • AARP Medicare Complete*
  • Aetna
  • Blue Cross Blue Shield (most plans)
  • Cigna
  • Federal Blue Cross Blue Shield
  • Humana
  • Medcost
  • Medicare
  • Medicare Advantage Plans*
  • State Blue Cross Blue Shield
  • TriCare
  • United Healthcare

*Call to verify our participation.

If you do not see your insurance listed, you should contact your insurance company to verify your network status and our participation. If your insurance carrier requires a referral, please make sure you have the proper documentation before coming to your appointment.

Please provide us with a copy of your current insurance card. If the information is not complete and up to date, we will not be able to file your claim and you will be billed.

Copay and deductibles are due at the time of service.  Payment collected at time of service is an estimate only based on the information available at the time of service.  If a balance is due after your insurance has paid, payment in full is due upon receipt of billing statement.

While there may be exceptions, cosmetic services and other non-covered services are not reimbursed by insurance.  If you have any questions regarding coverage for these services, we recommend that you speak with your insurance representative before your visit with us.

All lab work, including pathology, is sent to labs outside of our office.  The lab we use, selected on the basis of quality and service, may or may not be part of your health plan. These charges are separate from ours and they will bill you directly.

Medical Insurance Terms

Billed Amount – the full cost of an office visit or procedures performed at our office.

Allowed Amount – the amount your insurance company allows us to receive for the services we provide. Pricing is different per plan and is set by your insurance company.

Adjustment Amount – the difference between the full cost of our services and what an insurance company allows us to receive as payment; the ‘insurance discount’. As long as a claim is processed as in-network, the adjustment amount is written off, and is never passed on to the patient.

Date of Service – the date of your visit.

CPT® Code – Current Procedural Terminology (CPT®) code; codes created by the American Medical Association to describe the treatments or services provided to you by your doctor. These codes are standard across all insurance companies, and allow physicians to bill uniformly.

Diagnosis Code – Also known as the International Classification of Diseases (ICD-x) code, this was developed by the World Health Organization. American medicine is currently using the ICD-10 code set or the ninth version. These codes are used to identify and describe a patient’s illness or symptoms. These codes work in conjunction with CPT codes.

Explanation of Benefits –The EOB is a statement detailing how a claim was processed by your insurance company. It usually lists the CPT® codes, the diagnosis codes, the billed amount, the allowed amount, the adjustment amount, and any amount paid by insurance or responsibility given to the patient. The EOB also lists denied claims and gives reasons for denial.

Deductible – A set amount that must be paid by the patient before an insurance company will pay any expenses.