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Billing & Insurance

Dermatology is considered a specialty in the medical world and we frequently perform procedures in addition to speaking with you about skin concerns. Your insurance plan determines whether you are responsible for paying all or part of your visit, it is your responsibility to know what your plan pays for. Many insurance plans have different pricing for specialty visits.  Also, many of our patients have surgical procedures performed during their visit. Specialty office visits include verbal treatment plans, over the counter drug recommendations and prescription drug management. Surgical procedures include any procedure done in the office (surgery, biopsies, destructions/freezes, injections, PDT, and UPT’s). It is important for you to know if your plan has a deductible, surgical deductible, or has different prices for specialty visits.

For questions regarding billing or insurance, email our billing department at billing@audubondermatolgy.com. 

Questions you may want to ask your insurance company before your visit to Audubon Dermatology.

  1. Do I require a referral or prior authorization to see a specialist doctor?
  2. Do I have a Surgical-Procedure copay and/or deductible?
  3. Will I be responsible for any laboratory or pathology fees?
  4. Am I covered for Outpatient services in a non-facility setting?
  5. Are there any exclusions for certain conditions? For example, some plans do not cover acne, hair loss, hyperhidrosis, corns and calluses, etc.
  6. Are Telehealth Services covered under my insurance plan? (i.e. Virtual Synchronous visits, Telephone Consultations, and Store-N-Forward Asynchronous visits)

Below are the most common insurance codes for Dermatology visits:

  • New Patient Visits: 99202 or 99203 (modifier -95 or -GQ for telehealth)
  • Established Patient Visits: 99212, 99213, or 99214 (modifier -95 or -GQ for telehealth)
  • Biopsy/Destructions (Lesions of concern procedures): 11102, 17110, 17000
  • Injections (Acne, Scar, Hair Loss): 11900
  • Mole Mapping (TB Photography): 96904
  • Misc. information you may need when calling your insurance: Tax ID #: 20-4264241, place of service-11,

If you have a deductible within your insurance plan, (medical, surgical, and/or laboratory) you are responsible for any charges until your deductible is met. Here is a little cheat sheet on the most common types of insurance plans.

  • Strictly Copay Plans:  You pay a fixed amount per visit.
  • Strictly Deductible Plans: You pay the allowed amount contracted by your insurance plan for the services rendered by a medical office until you reach your deductible. After you have reached your deductible, you may be subject to a coinsurance percentage until your Out of Pocket Max has been met for the calendar year.
  • Office Copay & Surgical Deductible Plans: A combination of the above two types of plans. It is your responsibility to know your plan.

ACCEPTED INSURANCES:

Aarp Healthcare Options/United Healthcare 
AARP UHC Medicare SolutionsNeed a referral.
Advantra HMO CoventryNot a provider.
Aetna HMO/PPO 
Aetna Manage ChoiceNeed a referral unless with Open Access
Aetna Elect ChoiceNeed a referral unless with Open Access
Aetna SelectNeed a referral unless with Open Access
Aetna Better HealthNot a provider.
Aetna Continental Insurance Company 
Allied Benefit Systems 
Ama Insurance Agency 
AmCareNot a provider.
American Continental Life (Genworth) 
American Health Resources 
American Public Life Insurance Company 
AmeriGroup/Healthy BlueNot a provider.
Anthem Blue Cross 
Apwu Health Plan 
Banker’s Life 
Bayou HealthNot a provider.
Best CareNot a provider.
Blue Advantage HMO 
Blue Cross Blue Shield Of Mississippi HMONeed a referral, out of state.
Blue Cross Blue Shield Magnolia LocalNot a provider.
Blue Cross Large Groups with unique benefits (Ochsner Health Systems)Not a provider.
Blue Cross Blue Shield Signature Blue 
Blue Cross Blue Shield Community BlueNot a provider.
Blue Cross of Louisiana Federal Plan 
Blue Cross of Louisiana HMO/POS 
Blue Cross Of Louisiana PPO 
Blue Cross of Lousiana Office of Group Benefits (OGB) 
Champva 
Christian Brothers Employee Benefit 
Cigna 
Continental General Insurance Company 
Coventry Healthcare Of La. 
Coventry AdvantraNot a provider.
Empire Blue Cross 
Employer Plan Services, Inc 
Equian 
Freedom Life Insurance Company of America 
Geha / United 
Gilsbar 360 
Gilsbar / Peoples Health Employees 
Gilsbar (St. Tammany Parish PPO)Not a provider.
Gilsbar (EJ/WJ Hospitals)Out of Network, patient coinsurance 40%.
Golden Rule Insurance (United Health Care) 
HealthSmart Benefit Solutions 
Humana Gold 
Humana Gold Plus Diabetes (HMS SNP)Not a provider.
Humana Gold Plus Diabetes and Heart (HMS SNP)Not a provider.
Humana Total Care AdvantageNot a provider.
Humana OchsnerNeed a referral.
Humana PPO / HMO 
Humana MilitaryNeed a referral
LAHAPNot a provider.
Liberty Healthshare 
Louisiana MedicaidNot a provider.
Mail Handlers Benefit Plan 
Masters,Mates& Pilots Health 
Medicare/Medicare Dual ProgramNot a provider.
Medicare 
Medigap Claims Administrator/Transamerica 
Meritian Health 
Mutual Of Omaha 
Nalc Health Benefit Plan 
New Orleans Electrical Health Plan 
Noe-ila Field Office 
Oxford Health 
PAI 
Peoples Health Network/Choices 65 
Physician’s Mutual 
Pomco Group 
Ppo Plus 
Providence Health Plan 
Retiree Medical Insurance Plan 
Rr Medicare 
Secure Health LouisianaNot a provider.
Signature Blue 
Starmark 
State of LA Dept of the Treasury 
Stirling Benefits 
The Hartford 
Tricare For Life 
TRICARE WPS VACAANeed a referral.
Tufts Health Plan Direct 
UMR 
United Healthcare – BUPA/SHELL 
United Healthcare Choice Plus 
United Healthcare Community PlanCheck your Out of Network benefits. We are not In Network for these plans. You need a referral.
United Healthcare CompassCheck your Out of Network benefits. We are not In Network for these plans. You need a referral.
United Healthcare GE Health Choice 
United HealthCare Medicare Solutions 
United Healthcare NTCA 
United HealthCare One Plan 
United HealthCare Student Resources 
United Teachers Association 
UnitedHealth Integrated Services (GEHA) 
USAA Life Ins. 
VA HealthcareNeed a referral.
Vantage Health Plan 
Washington National Ins. Co. 
WebTPA/LSU First 
Wellcare Not a provider.

 

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