Patient Information

We welcome our current and new patients to the Central Carolina Dermatology Clinic website. We trust you will find answers to your questions and that this information will make things easier for you when you visit our office!

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General Information

• Please arrive promptly for your appointment.  If you cannot keep your appointment, we ask that you notify us at least 24 hours in advance of your appointment time.  
• All patients should bring their current insurance card and photo identification.  Copays are collected at check in.
• Please provide your referral upon check in if your insurance requires one.

New Patient Information

• New patients should arrive 15 minutes prior to their scheduled appointment to complete paperwork.  
• Unless prearranged, a parent should accompany their child if under the age of 18.

Refills

• Please contact your pharmacy if you need a refill.  We only process these during normal office hours.  Please allow 2 business days for refill processing.

Patient Forms

New patient forms

All new patients will need to complete each of these forms.  Print, complete and bring to your appointment or you may mail or fax them to us.

• New Patient Demographic Form
• Authorization for Release of Information to Family/Friends Form
• Patient Health Information Form

Consent form

• Give Consent for Treatment of Minor Child
  

Medical Record request forms

If you would like a copy of your medical records, print and complete this form and mail or fax to us.  There may be a fee associated with this request.

• Request to Access and Copy Information Form

If you would like to request a copy of your medical record to be sent to another provider or to request another provider to send a copy of their medical record for you to us, print and complete this form and mail or fax to us.

• Authorization to Release Health Information to a Health Care Provider Form

ADDRESS: 404 Westwood Ave Suite 107 High Point, NC 27262

FAX: (336) 887-3194

Insurance Plans We Participate With:

• Aetna
  HMO, QPOS, US Access, Aetna Choice Pos, Elect Choice, Managed Choice, Open Choice, HMO Open Access.
• Blue Cross Blue Shield
• Cigna Open Access, PPO, HMO or POS
• Coventry Health care National
  Mail Handlers, APWU, NALC, Hartford, Liberty Mutual, Travelers, Healthcare Preferred
• First Health
• Great West
• Humana / Choicecare PPO
• Medcost
  ACS, Benefit Management, Celtic, Federated, Interactive Medical, John Alden, Penn Western
• Medicaid
  Carolina Access- referral required by practice noted on card
• Medicare
  Aetna MCR, Advanta Freedom, BCBS HMO & PPO, Evercare, Humana Gold, Pyramid Todays Options, UHC MCR complete, AARP, Secure Horizons, Unicare Secure Choice, Railroad MCR, Wellcare, America's 1st Choice
• PHCS
  PPO or MD Plan, Multiplan (not PHCS if card says POS Plan)
• Primary Physicians Care
• Tricare Standard and Tricare for Life-we are not contracted, but we do give a discount
• United Health Care
• Commercial Plans & Medicare replacements, such as Evercare, Secure Horizons and UHC MCR Complete
• Wellpath

revised 7/1/10

Payment Options

• Central Carolina Dermatology Clinic accepts cash, checks, Visa, MasterCard and Discover.
• We also have payment plans available for self-pay patients. Please ask our billing department for details.

Billing for Office Visits and Surgical Procedures

We want to help you understand how medical insurance covers office visits and procedures.  When you have a co-payment, some insurance carriers apply it to the office visit (evaluation and management) meaning time with the health care provider to give advice and write prescriptions.  Any procedure done in the office such as freezing or removing skin lesions, treating warts with medication, skin biopsies is considered a surgical procedure according to the American Medical Association and is therefore classified as that according to Medicare and commercial insurance billing guidelines.  When these surgical procedures are medically necessary, they may be covered by your plan, but usually fall under a different section of your insurance coverage and may be subject to a deductible.  It is important for you to understand your insurance coverage so you will not be surprised when you get your explanation of benefits from your insurance carrier and bill for our services.

When possible, we often evaluate your condition and perform the procedure during the same appointment time.  We find that this is more convenient for the patient rather than scheduling another appointment for the procedure.  This also expedites the diagnosis and treatment of your condition.  These will be identified as separate items on your insurance explanation of benefits and our billing statements.

Privacy Policy

Our Privacy Policy describes how medical information about you may be used and disclosed and how you can get access to the information. Please CLICK HERE to review our entire Privacy Policy.

Patient Bill of Rights

• A patient has the right to good quality care and high professional standards that are continually maintained and reviewed.
• A patient has the right to have his or her medical records treated under the HIPAA guidelines for privacy.
• A patient has the right to make informed decisions regarding his or her care and has the right to include family members in those decisions as long as they meet the HIPAA guidelines.
• A patient has the right to have any service, procedure, or fee explained upon request. A patient has the right to be treated with respect.

Patient Responsibilities

• A patient is responsible for providing correct and complete information about their health, past medical history and insurance.
• A patient is responsible for reporting if they do not understand the planned treatment or their part in the plan.
• A patient is responsible for following the recommended treatment plan they have agreed to by keeping their appointments.
• A patient is responsible for payment of all charges not covered or unauthorized by his or her insurance carrier, as well as, any associated court costs, collection fees, or other remedies required to collect delinquent accounts.
• A patient is responsible for co-payments and deductibles at time of service.
• A patient is responsible for referrals (if required by their insurance), or they may reschedule, or be considered private pay.
• A patient is responsible for treating others with respect.