PATIENT RESPONSIBILITY STATEMENT
Your portion of the charges are to be paid at the time of service. Be familiar with what your insurance company does and does not cover. You are responsible for paying any deductible amount, co-insurance, or any other balance not paid for by your insurance. To find out more information about your insurance coverage, please call the customer service phone number listed on your insurance card or contact your employer for more information.
You will receive a billing statement from Associated Skin Care Specialists, P.A. once your insurance company has paid the claim and there is a co-insurance, deductible, or non-covered service for which you are responsible. Statements are mailed once each month. Payment of your bill is ultimately your responsibility and due upon receipt of your first statement. Finance charges are assessed for balances over 60 days old.
NO INSURANCE OR PRIVATE INSURANCE
We have an experienced Business Office to assist you with payment options. We also have a financial hardship program that you may qualify for.
If you are a new patient and do not have insurance coverage, our policy is to collect payment in full at the time of your visit. Please contact our business office (763-502-2951) to discuss estimated charges to arrange payment.
PAST DUE BALANCES
Our staff will work with you to create a payment plan that is suitable for you and Associated Skin Care Specialists. If the payment plan is not kept or your balance is not paid in a suitable time frame, Associated Skin Care Specialists will send your balance to a collection agency for collection. At that time, your debt will be reported to the credit bureau.
METHODS OF PAYMENT ACCEPTED
We accept credit cards including Visa/Mastercard/Discover. Your personal check or cash is also welcome. You can mail a check or the completed credit card form on the front of your billing statement to the address listed below:
Associated Skin Care Specialists, P.A.
7205 University Ave NE
Fridley, MN 55432
We now offer the convenience of online Visa/Mastercard/Discover payment services. You can also call our business office to pay by credit card over the phone.
CODING FOR SERVICES
All healthcare providers bill services using CPT billing codes. Federal law requires appropriate, accurate coding. Coding must reflect what happens during your medical visit and match what is recorded in your medical record. Please review and understand the contract you have with your insurance company. Under the Affordable Care Act (ACA), specialty care providers cannot use preventative visit CPT billing codes. We are here to assist you! Please call our business office (763-502-2951) with any questions.
FINANCIAL POLICY AND BILLING
- Co-payments are due at time of service
- Payment of cosmetic services is due at the time of service
- Credit/Debit Cards (Visa/MasterCard/Discover)
- Returned checks will incur a $30.00 processing fee
AUTHORIZATION TO RELEASE INFORMATION
Your authorization is necessary in order for us to provide your insurance company with the information they need to process your claim. Your authorization is kept in our files for one year, from the date originally signed, unless revoked in writing by the patient. Please be aware that we will be asking you to fill out an Authorization to Release Information form annually.
ASCS will submit your bill to either the employer responsible or the workers compensation insurance company along with your medical records, as required by Minnesota State Law. You are required to provide the information (First Report of Injury) to us for billing. If you have an attorney involved in your workers compensation case, please provide us with their name and telephone number.
Associated Skin Care Associates has partnered with CareCredit to offer you additional financing options for procedures and services. Now you can pay online with CareCredit. Take care of outstanding medical bills quickly and securely. Pay online up to 120 days after your visit, or for goods and services to be received within 30 days.
Click the button below to apply now or to make a payment on an existing account.