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Polley Clinic of Dermatology
and Dermatologic Surgery, P.A.
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Medical Insurance Policies
If we do not have a contract with your medical insurance company, or if you do not have medical insurance, payment in full is expected at the time of your visit.
You will be required to show a copy of your insurance card at each visit. If you do not have your insurance card or we are unable to verify your coverage, payment in full is expected at the time of your visit.
Please be aware that some or all of the services that you request, or that your provider feels are necessary, may not be considered medically necessary under Medicare, Medicaid, Blue Cross, or any other medical insurance. Such services would not be paid by any insurance company. Payment in full is expected at the time of your visit. Please ask for a written cost of services estimate before any services are performed.
Medicaid patients must have a current card. Medicaid patients over age 21, except those with a pink pregnancy card and those in institutions, must pay a $3.00 co-payment.
Carolina Access Medicaid patients must have written prior approval from their Primary Care Doctor for every visit. If you change Primary Care Doctors, new referrals are needed.
All checks are verified. A $30.00 fee is charged for bad checks.
Deductibles and co-payments must be collected at the time of your visit. It is not our responsibility to know your deductible status. If you do not know your deductible status, payment in full is expected at the time of your visit.
Office visit charges do not include laboratory tests, injections, biopsies, surgical procedures, medications, and supplies. These services are at additional cost. Please ask for a written cost of services estimate before any services are performed.
Minor and Imcompetent Patients: North Carolina law regarding minor or incompetent patients states that the party seeking or authorizing treatment of such a patient is responsible for paying the bill. Arrangements between any other parties have no force or effect on Polley Clinic of Dermatology and Dermatologic Surgery P.A.
If your account becomes delinquent, you will be held liable to pay all collection company or attorney fees.
Ask for a written cost of services estimate before any services are performed. If you change Primary Care Doctors, new referrals are needed.
Refunds for any reason are issued by the 15th of the next month.
We accept:
Medicare AETNA
Medicaid First Health
Blue Cross Blue Shield CIGNA
MedCost Perdue Farms
If you have any other insurance provider please call 1-877-895-7394. | |
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