Financial Policy

• Your health insurance coverage represents an agreement between you and your insurance carrier. As a courtesy to our patients, our staff will submit claims on your behalf. However, as the patient (or the guarantor), you are responsible for payment of any charges not covered by your insurance plan.

Please bring the following items to each visit

• Your current health insurance card(s)
• A valid driver’s license or photo ID
• A form of payment

Appointments

• It is your responsibility to confirm that your provider participates with your insurance plan and that all necessary referrals or authorizations have been obtained prior to your appointment. If this is not completed, you may be held financially responsible for any associated costs.
• Patients who arrive without a valid required referral will be asked to sign a waiver acknowledging full financial responsibility if the referral cannot be secured by the time of the appointment. A credit card will also be required to process payment if needed.
• Please inform the front desk staff of any updates to your insurance, address, or contact information at check-in. Failure to provide accurate information may result in denied claims, making you responsible for unpaid balances.
• A minimum of 24-hours notice is required to cancel or reschedule an appointment. Missed appointments without proper notice will incur a $50 fee.

Payments

• All copayments, coinsurance, deductibles, and non-covered services (including cosmetic procedures) are due at the time of service.
• We accept cash, checks, money orders, Discover, Visa, MasterCard, and American Express.
  You will be charged a $25 returned check fee for any payments returned by your bank.

Self-Pay Patients

• Patients without health insurance will be charged $225 for the office visit plus the cost of any procedure(s). We will be happy to provide you with an estimate of charges at your request prior to the procedure being performed.
• Anything removed from the skin will be sent to an outside laboratory for analysis. Any questions about lab fees should be directed to the lab.

Outstanding Balances & Collections

• Accounts with unpaid balances older than 60 days may be assessed a $10 monthly statement fee.
• Balances outstanding beyond 60 days from the date of service may be referred to a collection agency, and a $50 collection processing fee will be added to the total amount due.
• Patients with delinquent or collection accounts may be dismissed from the practice.

Payment Arrangements

• Our billing department is available to discuss payment plan options for outstanding balances.
• Payments may be made:
  • By mail: 176 S. New Middletown Road, Suite 203, Media, PA 19063
  • Online: www.adaderm.com
  • By phone: 610-566-7300

Refunds

• Refunds are issued to the appropriate responsible party after verification.
• Refunds will not be processed until all outstanding or pending charges are satisfied in full.

Date: 10/12/2025