INSURANCE INFORMATION


 

Before scheduling your initial appointment, please call your insurance company to confirm you are in network with Northstar Dermatology. Also, please confirm whether or not your plan requires a referral from your PCP to see a specialist! Most HMO plans will require a referral, but some PPO plans might require one as well. We always advise that you double check so you aren’t stuck with an unexpected balance! Keep in mind that it is the patient’s responsibility to verify that Northstar Dermatology is a participating provider, and that your plan is active at the time of your service.

 

QUESTIONS TO ASK YOUR INSURANCE COMPANY:

 

1. Is Northstar Dermatology in my provider network?

If Yes, ask these questions:

- What are my benefits for a specialist office visit? Do I have a copay, or a deductible?

- What are my benefits for any procedures performed in office? Will the procedures also be covered by my copay, or will they apply to a deductible?

If No, ask these questions:

- Does my plan have out-of-network benefits? If yes, what portion of my bill am I responsible for?

2. Before I see a doctor at Northstar Dermatology, do a I need a referral from my primary care physician?

3. Does my plan cover any lab tests or pathology tests that may be needed following my visit at Northstar Dermatology?

 

INSURANCE WE ACCEPT

 

Due to the constant changes in the insurance market, certain plans may not be listed below. If you do not see your insurance on this list, we recommend that you call your insurance and check if we are a participating provider with your plan. Also, keep in mind that even if your insurance plan is listed below, there can be certain exclusions. Be sure to confirm with your insurance that you are in network.

 

INSURANCE ACCEPTED  

  • Aetna PPO/HMO*/EPO/POS
  • Aetna Medicare Advantage PPO/HMO*
  • AARP Medicare Advantage
  • BlueCross BlueShield PPO/HMO*/Federal
  • BlueCross BlueShield Medicare Advantage PPO
  • Care N’ Care (Out of network benefits)
  • ChampVA
  • Coventry
  • First Health
  • Galaxy Health Network
  • GEHA (United Healthcare Shared Services)
  • Healthcare Highways
  • HealthSmart Accel/GEPO/PPO
  • Humana PPO
  • Humana Medicare PPO/PFFS
  • Imagine Health
  • Imperial Medicare Advantage
  • IMS (Independent Medical Systems) PPO
  • Medicare Part B
  • Railroad Medicare
  • Mutual of Omaha Medicare Advantage
  • PHCS/MultiPlan
  • United Healthcare
  • UMR
 

 

INSURANCE FAQ's

 

Will my visit be covered by my insurance?  Most dermatology services are considered medically necessary by insurance. However, this does not mean that your insurance will pay 100% of the cost of your service. This is completely dependent on your Specialist Office Visit and In-Office Surgical benefits (you’ll want to call your insurance for your plan benefits). Services that are typically NOT covered by insurance include treatment or removal of cosmetic moles, skin tags, milia, seborrheic keratoses, and cherry angiomas. Not to worry – we have very reasonable pricing for treatment of the cosmetic lesions listed above. Finally, some insurance plans may have coverage exclusions for certain diagnosis (like certain types of hair loss, or acne). We advise that you contact your insurance directly to see if your particular plan has any exclusions for dermatology services.

 

How much will I have to pay? If you have insurance, your patient responsibility amount depends on your particular insurance benefits. Keep in mind that there are many different insurance plans, even within one insurance company, and member benefits vary from plan to plan. We advise that you contact your insurance directly to find out what you will pay for your Specialist Office Visit and any In-Office Surgical Procedures you might have.

 

What if I don't have insurance? No problem! We offer self-pay discounts for our office visit exams as well as surgical procedures. An office visit will range from $95 - $150 depending on the level of visit. If you need a procedure performed in office, we would be happy to provide you a quote after you are evaluated.

 

Insurance benefits explained! Copay: A fixed amount a patient will pay for an office visit examination. Patients will often have two different copay amounts – one for their PCP and one for a Specialist. We are a Specialist. Coinsurance: If you don’t have a copay for your benefits, you likely have coinsurance instead! Coinsurance is the percentage (%) that the patient is responsible to pay for an office visit examination or surgical services AFTER the deductible has been met. For example, if a patient has 20% coinsurance for their specialist office visit, the patient would be responsible for 20% of the total cost of the visit, and the insurance company would pay the remaining 80% of the visit. Keep in mind, this is only after the deductible is met.

Deductible: The total amount that a patient has to pay towards their healthcare before insurance will cover any costs. Out of Pocket: The maximum amount that a patient will have to pay for their healthcare expenses. Once the patient has met the out-of-pocket amount, insurance will cover 100% of covered costs for the remainder of the year. Scenario 1: Patient’s Specialist Office Visit Benefit: $50 copay Patient’s Surgical Benefit: 20% coinsurance Patient’s Deductible: $2,000.00 total / $2,000.00 remains (meaning the patient has not paid anything towards their deductible) If the patient is seen for an exam only (no procedures), the patient is responsible for paying their $50 office visit copay. If the patient has a procedure performed, the patient is responsible for paying the full cost of the procedure towards their deductible, since the deductible has not been met. Although the patient has 20% coinsurance for their surgical benefit, remember that this means the patient only pays 20% AFTER the deductible has been met. Scenario 2: Patient’s Specialist Office Visit Benefit: $50 copay Patient’s Surgical Benefit: 20% coinsurance Patient’s Deductible: $2,000.00 total / $0.00 remains (meaning the patient has already paid $2,000 towards their health services this year and therefore the deductible is met). If the patient is seen for an exam only (no procedures), the patient is responsible for paying their $50 office visit copay. If the patient has a procedure performed, the patient is responsible for paying only 20% of the total cost of the procedure since they have already met their deductible. The insurance company will pay the remaining 80%. Scenario 3: Patient’s Specialist Office Visit Benefit: 20% coinsurance Patient’s Surgical Benefit: 20% coinsurance Patient’s Deductible: $1,000.00 total / $400.00 remains (the patient has paid some money towards their deductible, but it is not yet met). If the patient is seen for an exam, the patient is responsible for paying the full cost of the exam towards their deductible, since the deductible has not been met. Remember that with coinsurance, insurance will not cover any of the visit until the deductible has been paid. If the patient has a procedure performed, the patient is responsible for paying the full cost of the procedure towards their deductible, since the deductible has not been met.

Scenario 4: Patient’s Specialist Office Visit Benefit: 20% coinsurance Patient’s Surgical Benefit: 20% coinsurance Patient’s Deductible: $1,000.00 total / $0.00 remains (the patient has already paid $1,000 towards their health services this year and therefore the deductible is met). If the patient is seen for an exam, the patient is responsible for paying only 20% of the total cost of the exam fee since they have already met their deductible. The insurance company will pay the remaining 80%. If the patient has a procedure performed, the patient is responsible for paying only 20% of the total cost of the procedure since they have already met their deductible. The insurance company will pay the remaining 80%.

 

 

 

 

 

Location
Northstar Dermatology
8169 Precinct Line Road , Building 2
North Richland Hills, TX 76182
Phone: 817-369-8518
Fax: 817-427-3379
Office Hours

Get in touch

817-369-8518