PATIENT FORMS
Welcome to Olney Dermatology Associates.
Please arrive 15 minutes early and bring all forms with you.
Policies
A. Insurance
Our office is out-of-network for all major insurance plans, except for Medicare. At the time of service our staff will provide you with a receipt with all the necessary information and codes required by your insurance company to process your claim. We will also provide you with a health claim form (HCFA) with the diagnosis and service codes filled in so that your claim may be mailed out the same day of service. You will be reimbursed directly by your insurance company according to your specific policy.
B. Payment
We accept all major credit cards, cash and checks. Payment is due at the time of service. We do not bill or accept assignment from insurance companies.
C. Cancellations
As a courtesy to all of our clients we ask that all cancellations be made at least 24 hours in advance of the scheduled appointment time. Failure to comply with this request may lead to a $25 "no show" fee.
Full Description of HIPPA Policy
Health Insurance Portability and Accountability Act (HIPPA)
Our office fully complies with the regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This notice describes how health information about you (as a patient of this practice) may be used and disclosed, and how you can get access to your individually identifiable health information. We at Olney Dermatology Associates are dedicated to maintaining the privacy of your individually identifiable health information (IIHI). In conduction of our business, we will create records regarding you and the treatment and services we provide to you.
We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your IIHI. By federal and state law, We must follow the terms of the notice of privacy practices that we have in effect at the time. We realize that these laws are complicated, but we must provide you with the following important information:
- How we may use and disclose your IHII.
- Your privacy rights in your IIHI.
- Our obligations concerning the use and disclosure of your IHII.
The terms of this notice apply to all records containing your IIHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of your current Notice in our office in a visible location at all times, and you may request a copy of our most current Notice at any time.