Goodskin Cancellation/"No-Show" Policy
CANCELLATION AND NO-SHOW POLICY FOR APPOINTMENTS AND SURGERY
1. Cancellation/ No Show Policy for Appointments
We understand there are times when you must miss an appointment due to emergencies or obligations for work or family. However, when you do not call to cancel an appointment or do not show for an appointment, you may be preventing another patient from getting much needed treatment.
Conversely, the situation may arise where another patient fails to cancel and we are unable to schedule you for a visit.
If an appointment is not cancelled at least one (1) business day in advance you will be charged a one hundred dollar ($100) fee (as allowed by carrier). This will not be covered by your insurance company, and you will be responsible for payment of these charges. In the case that your insurance carrier does not allow this fee, you will only be allowed to schedule same day appointments as the schedule allows.
2. Cancellation/ No Show Policy for Surgery
Due to the large block of time needed for surgery, if your surgical appointment is not cancelled at least two (2) business days in advance, you will be charged a two hundred dollar ($200) fee. This will not be covered by your insurance company, and you will be responsible for payment of these charges.
3. Scheduled Appointments
We understand that delays can happen. However, we must try to keep the other patients and providers on time. If a patient arrives more than 10 minutes past their scheduled time, we will reschedule the appointment. Please note: We cannot accept cancellations via voicemail.
4. Payment of Fees
You must pay any incurred fee(s) prior to scheduling your next appointment. If you are already scheduled for an appointment at the time a fee is incurred, you may keep the appointment, but no additional appointments will be scheduled until payment is received.
Contacting Us
If there are any questions regarding this policy you may contact us using the information below.
Goodskin Dermatology
12605 SE 97th Avenue
Clackamas, OR 97015
Phone 503-654-SKIN
1. Notice of Privacy Practices (NPP)
Notice of Privacy Practices (NPP)
Effective Date: 2024
Your Information. Your Rights. Our Responsibilities.
This notice explains how your medical information is used and protected.
How We Use Your Health Information
We use your health information to:
- Provide medical care and treatment
- Pay for medical services
- Run healthcare operations
- Comply with laws and regulations
Our Responsibilities
We are required by law:
- To keep your medical records safe and private
- Use security measures to protect your information from being lost, stolen, or misused.
- We will inform you promptly if a breach occurs.
Sharing Your Information
We may share your health information:
- With doctors, nurses, and other healthcare providers who are involved in your care
- With insurers to process your claims
- As required by law (e.g., for public health reasons or legal requests)
Your Rights
You have the right to:
- Access and get a copy of your health records
- Ask us to contact you in a specific way
- Request changes to your health records if you find errors
- Ask for limits on how your information is used or shared
- Receive a list of who your information has been shared with
- File a complaint if you believe your privacy rights have been violated
Changes to This Notice
We reserve the right to change the terms of this notice, and the changes will apply to all information we have about you. A copy of the revised notice will be available upon request, in our office, and on our website.
Contact Information
For questions about this notice or to exercise your rights, please contact:
Privacy Officer
Phone: 503.654.7546
Email: [email protected]
Address: 12605 SE 97th Ave Clackamas, OR 97015
2. Financial and Billing Policies
GOODSKIN DERMATOLOGY FINANCIAL POLICY
This policy reviews your financial obligations when services are provided to you at Goodskin Dermatology.
- Goodskin Dermatology is contracted with many insurance companies. You are responsible for any copayments, coinsurance and deductibles.
- Goodskin Dermatology offers Auto Pay, utilizing a credit card on file, in case of further patient cost responsibility after insurance adjudication of their visit. This Card on File system allows for smoother transactions and billing for our patients and will allow that Goodskin to collect for services rendered in a timely manner from all patients.
- Options for Card on File include:
- HSA
- HRA
- FSA
- Debit card
- Credit Card
- Options for Card on File include:
- Private Pay Dermatology and Aesthetic Patients are required to put a card on file before services. This card will be charged at the end of the visit if no other form of payment is offered.
- Aesthetic services are not covered by insurance. Payment for these services is required, in full, at the time of service and is non-refundable.
- Prepaid aesthetic package must be used within one (1) year of purchase date.
- All procedures are billed separately and are not included in an office visit. These procedures generally fall under ‘patient deductible.’
- If your insurance requires a referral, we must receive your referral prior to your visit.
- If you have questions or concerns about what your insurance company will cover or network participation, please contact your insurance company before your visit.
- If you do not have insurance, payment is due in full at the time of service – good faith estimates are available.
- Responsibility for minor/dependent accounts lies with the legal guardian who accompanies the minor to the visit.
- Pathology is billed separately by the laboratory to which the sample is sent.
- Account statements are available in you ‘Patient Portal.’ If a balance is overdue, we make every effort to contact the patient before sending the account to collection.
- A NO SHOW or cancellation without at least one (1) business day notice may be charged $100.00 and Surgery Appointments will be subject to an additional $100.00 fee ($200 total).
- We require a Credit Card on File to secure appointment times for patients that have missed appointments in the past.
I hereby authorize Goodskin Dermatology to release any required medical information regarding my medical conditions to my insurance company or the Health Care Administration and its intermediaries. I agree that I am responsible for the payment of any amounts not paid by my insurance carrier, according to the plan provisions of my insurance policy. I have read and understand this financial policy, and I agree to comply with these terms for services provided at Goodskin Dermatology.
GOODSKIN DERMATOLOGY FINANCIAL POLICY FAQs
- You are responsible for any copayments, coinsurance and deductibles.
- You can sign up for Auto Pay or pay online.
- Cash Pay patients are required to put a card on file before services.
- Procedures are often applied to ‘patient deductible.’
- Covered’ procedures are not always ‘Paid In Full’
- Depending on your plan, charges may be applied to your deductible.
- If your insurance requires a referral, we must receive your referral prior to your visit.
- Responsibility for minor/dependents lies with the guardian who accompanies the minor to the visit.
- Pathology is billed separately by the laboratory.
- A NO SHOW or cancellation without at least one (1) business day notice may be charged $100.00 and Surgery Appointments will be subject to an additional $100.00 fee ($200 total).
- We require a Credit Card on File to secure appointment times for patients that have missed appointments in the past.
NOTICE TO PATIENTS REGARDING THE NON SURPRISES ACT
Effective Date: January 1, 2022
Your Rights and Protections Against Surprise Medical Bills
As part of our commitment to transparency and patient care, we want to inform you about your rights under the No Surprises Act, which aims to protect you from unexpected medical bills.
What is a surprise medical bill?
A surprise medical bill occurs when you receive care from a healthcare provider or facility that is not in your health plan’s network, resulting in higher-than-expected charges. These unexpected charges are sometimes referred to as “balance billing.”
Key Protections Under the No Surprises Act:
- Emergency Services: You are protected from surprise bills for emergency services, regardless of whether you receive care at an in-network or out-of-network hospital.
- Non-Emergency Services: If you receive non-emergency services at an in-network hospital or ambulatory surgical center, you cannot be billed more than the in-network cost-sharing amount for services from out-of-network providers.
- Notice and Consent: If you are seen by an out-of-network provider at an in-network facility, the provider must give you a notice explaining that they are out-of-network and may ask you to sign a consent form agreeing to out-of-network charges. You have the right to refuse to sign this consent form.
What does this mean for you?
You are responsible only for your in-network cost-sharing amounts (e.g., copayments, coinsurance, and deductibles).You should not receive a balance bill from out-of-network providers for emergency services or certain non-emergency services. If you believe you have been wrongly billed, you have the right to dispute the charges.
How to get more information:
For more details about your rights under the No Surprises Act, you can visit the official Centers for Medicare & Medicaid Services (CMS) website or contact our office directly.
Contacting Us
If there are any questions regarding this privacy policy you may contact us using the information below.
Goodskin Dermatology
12605 SE 97th Avenue
Clackamas, OR 97015
Phone 503-654-SKIN
More information regarding the No Surprise Act can be found HERE.
3. Section 1557 of the Patient Protection and Affordable Care Act
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4. Appointment, Cancellation, and No-Show Policy
CANCELLATION AND NO-SHOW POLICY FOR APPOINTMENTS AND SURGERY
1. Cancellation/ No Show Policy for Appointments
We understand there are times when you must miss an appointment due to emergencies or obligations for work or family. However, when you do not call to cancel an appointment or do not show for an appointment, you may be preventing another patient from getting much needed treatment.
Conversely, the situation may arise where another patient fails to cancel and we are unable to schedule you for a visit.
If an appointment is not cancelled at least one (1) business day in advance you will be charged a one hundred dollar ($100) fee (as allowed by carrier). This will not be covered by your insurance company, and you will be responsible for payment of these charges. In the case that your insurance carrier does not allow this fee, you will only be allowed to schedule same day appointments as the schedule allows.
2. Cancellation/ No Show Policy for Surgery
Due to the large block of time needed for surgery, if your surgical appointment is not cancelled at least two (2) business days in advance, you will be charged a two hundred dollar ($200) fee. This will not be covered by your insurance company, and you will be responsible for payment of these charges.
3. Scheduled Appointments
We understand that delays can happen. However, we must try to keep the other patients and providers on time. If a patient arrives more than 10 minutes past their scheduled time, we will reschedule the appointment. Please note: We cannot accept cancellations via voicemail.
4. Payment of Fees
You must pay any incurred fee(s) prior to scheduling your next appointment. If you are already scheduled for an appointment at the time a fee is incurred, you may keep the appointment, but no additional appointments will be scheduled until payment is received.
Contacting Us
If there are any questions regarding this policy you may contact us using the information below.
Goodskin Dermatology
12605 SE 97th Avenue
Clackamas, OR 97015
Phone 503-654-SKIN
5. Patient Rights and Responsibilities
PATIENT RIGHTS AND RESPONSIBILITIES
Our practice is committed to providing high-quality, compassionate care. We believe that a respectful, cooperative relationship between our patients and healthcare team is essential. To support this, we have outlined the following rights and responsibilities.
Patient Rights
As our patient, you have the right to:
- Respectful and Dignified Care
- Receive care in a safe environment, free from discrimination, regardless of race, religion, gender, sexual orientation, or any other personal attributes.
- Privacy and Confidentiality
- Expect that your health information will be kept confidential as outlined in our Notice of Privacy Practices, unless you provide consent for sharing or as permitted by law.
- Clear Information and Communication
- Receive accurate, clear, and timely information about your diagnosis, treatment options, and prognosis in a language you understand.
- Have your questions and concerns addressed by your healthcare team.
- Participation in Your Care
- Be actively involved in decisions regarding your healthcare. You have the right to discuss your treatment plan, ask questions, and make informed decisions about your care, including refusing treatment when legally permissible.
- Access to Medical Records
- Access your medical records as permitted by law. You may request a copy of your records or ask for amendments if you believe there are errors.
- Care Coordination and Continuity
- Expect that referrals, test results, and other aspects of your care will be managed efficiently, with follow-up care arranged as needed.
- File Complaints or Concerns
- Express any concerns about your care without fear of discrimination or retaliation. You have the right to file complaints with our Privacy Officer or contact the Department of Health and Human Services if necessary.
Patient Responsibilities
As our patient, you are responsible for:
- Providing Accurate Information
- Share complete and honest information about your medical history, symptoms, medications, and any other details that may affect your care.
- Asking Questions and Seeking Clarification
- Communicate openly with your healthcare providers. If you do not understand something or need further information, please ask questions.
- Following Your Treatment Plan
- Work with your healthcare team to follow your agreed-upon treatment plan, including taking medications as prescribed, attending follow-up appointments, and adhering to care instructions.
- Respecting Appointment and Cancellation Policies
- Keep scheduled appointments or provide sufficient notice if you need to cancel or reschedule. This helps us provide timely care to all patients.
- Being Respectful to Staff and Other Patients
- Show respect to all staff, patients, and visitors. Abusive or disruptive behavior will not be tolerated.
- Understanding Financial Obligations
- Be aware of your insurance coverage and any out-of-pocket expenses. Make timely payments and communicate with us if you have questions about billing.
- Protecting Privacy
- Respect the privacy of other patients by not discussing or sharing information you may overhear while in our facility.
Thank you for partnering with us in your healthcare. By understanding these rights and responsibilities, you help create a supportive environment that promotes better health outcomes for everyone.
6. Contact Information for Complaints or Issues
CONTACT INFORMATION FOR COMPLAINTS OR ISSUES
We are committed to providing high-quality care in a respectful and safe environment. If you have questions, concerns, or a complaint regarding your experience with our practice, we encourage you to reach out to us directly. Your feedback helps us improve our services and address any issues promptly.
How to Submit a Concern or Complaint
If you have a concern related to privacy, billing, or any aspect of your care, please contact us through one of the following methods:
Privacy Officer
Phone: 503.654.7546
Email: [email protected]
Address: 12605 SE 97th Ave Clackamas, OR 97015
Please include details about your concern and your preferred method of contact so that we can reach you directly.