Patient Information

1. Valid Photo ID – Government Issued (i.e. a current Driver’s License)
2. ALL Insurance Cards: including primary, secondary, tertiary, and Medicare Cards
3. A valid credit card to leave on file

• Keep our phone number with you in case you need help locating our office: 425-201-5117.
• Check the map below or on the Contact Us page to familiarize yourself with our location
• Arrive 15 minutes early to allow time to process the above information into your medical record, re-verify insurance eligibility, and collect copay
• Call us if you think you will be late and we will do all that we can to help avoid having to reschedule you. No show fees ($75) apply for rescheduling or canceling within 48 hours of appointment. See No Show/Cancellation Policy in Financial Policies section below

This is required to allow your insurance to be billed for your visit. Failure to complete this will make you personally responsible for all bills. Please complete this before your appointment to avoid losing precious time from your appointment.

New patients are required to go to the following link and follow the directions below: 11873.portal.athenahealth.com

• After choosing/using a password and landing on your homepage, look at the left column and do the following:
• Click “My Health”
• Click “Medical Forms”
• Click “New Patient Registration Form”
• Read the form and scroll all the way to the bottom
• Click the empty box next to the words “I have read and understand the terms in the above document and agree to the eCommunications disclosure”
• Go down to the empty box next to the word “Name” and type your first and last name. (Ignore the other boxes unless you are signing for a child or someone who is not mentally able)
• Click the orange “Submit” button at the very bottom
• You’re done!

Feel free to browse the portal website to see how it can help you have a closer connection with our care team by giving you 24/7 access to making future appointments, lab results, visit and diagnosis summaries, refill requests, asking questions, billing information and statements, skin condition information handouts, and more!

Any copayment required by your insurance agency will be collected prior to checking in for your appointment. If you do not have a copay, a $35 down payment will be required and applied toward coinsurance, deductible, or any non-covered charges, and will be automatically refunded if all charges are covered after your insurance is billed.

We care about making the billing process as simple, easy, and environmentally friendly as possible. This allows us to focus on your medical care instead of unnecessary billing paperwork for us and you — no need for you to find your checkbook, a pen, an envelope, a stamp, a mailbox, and waste more time and trees. We require that all patients leave a credit card on file with our office. We will scan your card and store your card number in a PCI compliant manner. After your insurance applies the contracted discount to our fees and processes your claim for your doctor visit we will email you a statement for the amount that your insurance states is your responsibility, as shown on your official Explanation of Benefits (EOB) that your insurance company sends you and us. Your credit card will be charged for the outstanding balance 5 business days from the date of the statement.
If you would rather mail a check to our office you are welcome to do so. If you would like to pay with a different credit card or HSA card, you can do that by using our secure online payment portal, or you can call us to pay over the phone.

All late cancellations, late reschedules and no-show fees will be charged automatically to the credit card information we have on file. We provide several courtesy appointment reminders to you by calling, texting, and emailing you prior to your scheduled appointment date. If we cannot speak to you directly, we will leave a message for you. However, it is primarily YOUR RESPONSIBILITY to remember and keep your appointment.  After your first no show you will be required to pay the $100 no show fee and also put $150 on deposit before each future appointment is scheduled.  Any deposit you make will be applied toward any copay, cosinsurance or deductible for your visit as determined by your insurance company and any remainder after insurance processing will be refunded.  If you no show a second time, the required deposit amount will be $250 for each future appointment and handled the same way.    If you frequently no show or late cancel/reschedule appointments, you may be discharged from our practice.

Charges to your credit card will be declined if your card expires or the bank issues you a new card. If charges are declined, we will call you to get updated credit card information. If our calls are not returned within one week, a $35 declined payment fee may be applied to your account and a new statement will be mailed. Your account becomes delinquent if not settled within 15 days.

Your account becomes delinquent if not paid within 15 days after billing and the unpaid balance becomes subject to a monthly finance charge of $35. All unpaid accounts, regardless of size, are turned over to a collections agency and you will be terminated from the practice.

All returned checks will be subject to a $35 returned-check fee. If the check is returned for any reason, you have 7 days to contact our office to arrange another form of payment.

Past due balances must be paid in full before scheduling additional visits or other services.

All skin biopsies and other lab work are sent to an outside lab (LabCorp). They will bill separately for their testing and are in-network for most insurance plans. It is your responsibility to inform us if your insurance plan is not in network with LabCorp. We have not yet encountered any insurance plans that are not in network with LabCorp, but you should still check with your insurance.

The removal of benign skin growths is considered cosmetic and is not covered by insurance. Cosmetic removal fees are separate from any medically necessary evaluation or treatment done at the same visit, and must be paid in full at time of visit.

A parent(s) or legal guardian(s) must accompany a minor and is responsible for providing current insurance information for the minor as well as the payment for services provided, including credit card on file.

We accept a wide variety of insurance plans. Verifying the details of your insurance coverage is ultimately YOUR RESPONSIBILITY. You should call the number on your insurance card to verify that Dr. Matthew R. Gee at Dermatology Care Center, Maple Valley, WA is a covered provider for your plan. For those without insurance, we offer reduced pricing that reflects our administrative savings for time-of-service payment.

Some insurance plans may require a referral. They do this to save them money by limiting your access to healthcare, especially to keep you from being able to see specialists. Although we will attempt to make sure this has taken place, because this is the result of your contract with your insurance company, it is YOUR RESPONSIBILITY to make sure the referral has been sent. If a visit is denied because a referral has not been obtained, YOU WILL BE RESPONSIBLE for the cost of the visit.

Dermatology Care Center is an in-network provider for most of the major insurance plans – see List Below. IMPORTANT: It is ultimately YOUR RESPONSIBILITY to know if your specific insurance plan will cover you for your visit with us. Please always verify with your insurer for every visit to make sure you are covered.

• AARP (Medicare Supplement and Medicare Complete)
• Aetna
• Allied Benefit Systems
• Cigna
• Blue Cross Blue Shield – most plans – check your network
• First Choice
• First Health Network
• Healthcare Management Admin
• Humana
• Kaiser Foundation Health Plan of Washington
• LifeWise (Premera Blue Cross)
• Medicare
• Medicare / Railroad
• PacifiCare (United Healthcare)
•  Premera Blue Cross
• Providence Health Plan
• Regence Blue Shield – most plans – check your network
• United Healthcare

We do not accept the following plans due to difficulties our office has experienced when trying to work with these plans, such as significantly high administrative/regulatory burden and extraordinarily low reimbursement that unfortunately make it not feasible to serve patients:

• Washington Medicaid / Apple Health
• UnitedHealthcare Community Health Plan

Our philosophy is to encourage minor patients to include a parent, guardian, or other trusted adult in all aspects of their health care. We require that a parent or legal guardian accompany your child to his or her visit at our clinic. If your minor child arrives at the clinic unaccompanied or in the company of an adult other than a parent or legal guardian, we may need to reschedule the appointment. Late rescheduling fees as described in the Financial Policies section would apply. If you have any questions regarding this policy, please call us at 425-201-5117.

NOTICE OF PRIVACY PRACTICES FOR DERMATOLOGY CARE CENTER
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATIONPLEASE READ CAREFULLY
The Health Insurance Portability & Accountability Act of 1996 (“HIPAA”) is a Federal program that requests that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confidential. This Act gives you, the patient, the right to understand and control how your protected health information (“PHI”) is used. HIPAA provides penalties for covered entities that misuse personal health information. As required by HIPAA, we prepared the following explanation of how we are to maintain the privacy of your health information and how we may disclose your personal information.We may use and disclose your medical records only for each of the following purposes: treatment, payment, and health care operation. Treatment means providing, coordinating, or managing health care and related services by one or more healthcare providers. An example of this is a primary care doctor referring you to a specialist doctor. Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collections activities, and utilization review. An example of this would include sending your insurance company a bill for your visit and/or verifying coverage prior to a surgery. Health Care Operations include business aspects of running our practice, such as conducting quality assessments and improving activities, auditing functions, cost management analysis, and customer service. An example of this would be new patient survey cards.The practice may also be required or permitted to disclose your PHI for law enforcement and other legitimate reasons. In all situations, we shall do our best to assure its continued confidentiality to the extent possible. We may also create and distribute de-identified health information by removing all reference to individually identifiable information. We may contact you, by phone or in writing, to provide appointment reminders or information about treatment alternatives or other health-related benefits and services, in addition to other fundraising communications, that may be of interest to you. You do have the right to “opt out” with respect to receiving fundraising communications from us.The following use and disclosures of PHI will only be made pursuant to us after receiving a written authorization from you:

• Most uses and disclosure of psychotherapy notes
• Uses and disclosure of your PHI for marketing purposes, including subsidized treatment and health care operations
• Disclosures that constitute a sale of PHI under HIPAA
• Other uses and disclosures not described in this notice

You may revoke such authorization in writing, and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your prior authorization.

You may have the following rights with respect to your PHI: The right to request restrictions on certain uses and disclosures of PHI, including those related to disclosures of family members, other relatives, close personal friends, or any other person identified by you. We are, however, not required to honor a request restriction except in limited circumstances which we shall explain if you ask. If we do agree to the restriction, we must abide by it unless you agree in writing to remove it. The right to reasonable requests to receive confidential communications of Protected Health Information by alternative means or at alternative locations. The right to inspect and copy your PHI. The right to amend your PHI. The right to receive an accounting of disclosures of your PHI. The right to obtain a paper copy of this notice from us upon request. The right to be advised if your unprotected PHI is intentionally or unintentionally disclosed.

If you have paid for services “out of pocket,” in full and in advance, and you request that we not disclose PHI related solely to those services to a health plan, we will accommodate your request, except where we are required by law to make a disclosure. We are required by law to maintain the privacy of your PHI and to provide you the notice of our legal duties and our privacy practice with respect to PHI.

We are required by law to maintain the privacy of your PHI and to provide you the notice of our legal duties and our privacy practice with respect to PHI.

This notice is effective as of January 1, 2015 and it is our intention to abide by the terms of the Notice of Privacy Practices and HIPAA Regulations currently in effect. We reserve the right to change the terms of our Notice of Privacy Practice and to make the new notice provision effective for all PHI that we maintain. We will post a copy and you may request a written copy of the revised Notice of Privacy Practice from our office.

You have the right of recourse if you feel that your protections have been violated by our office. You have the right to file a formal, written complaint with our practice and with the Department of Health and Human Services, Office of Civil Rights. We will not retaliate against you for filing a complaint.

Feel free to contact the Practice Compliance Officer at (425) 201-5117 for more information, in person or in writing.