Welcome To Ironwood Dermatology GENERAL INFORMATION

Appointments
We see patients by appointment. Our staff will schedule the time needed to fully evaluate and treat your concerns.

No Show/Late Cancellation Policy (Effective January 1, 2011)
A No Show fee will be charged to your account if:

• You do not show up for your scheduled appointment
• You do not cancel your scheduled appointment at least 24 hours prior to your scheduled appointment time

This includes all established appointments, medical procedures, surgeries, cosmetic appointments and treatments. The fees are as follows:

• Cosmetic procedures are subject to a $150 charge
• Surgeries are subject to a $75 charge
• New Patient appointments are assessed a $50 charge
• All other appointments are subject to a $35 charge

If you miss 3 appointments without prior notice given, you will be dismissed from the practice.
No Show fees are due prior to or at your next appointment. No Exceptions.

Please contact our office at (520) 618-1630 as soon as possible to cancel or reschedule your appointment. Please provide at least 24 hours notice. We will attempt to contact you by phone with a courtesy reminder 1-2 days prior to your appointment.
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Arrival Time
New patients, please arrive at least 20 minutes prior to your scheduled appointment time. At your initial visit, you will need to allow yourself enough time to check in, have your IDs scanned into the system and give our reception personnel time to enter your information.
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What to Bring
• Completed Registration Form
• Signature on File
• Medical History including prescription, over the counter medications and supplements
• HIPAA Patient Consent Form
• Referrals and Authorization
• Insurance Cards
• Photo ID
We recommend you pre-register with our practice either by mail or via our website, www.ironwooddermatology.org. Please contact our office if you have not received your requested pre-registration forms by mail. We can then either fax or email those forms to you.
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Insurance Cards and Identification
All patients utilizing their insurance coverage are required to bring their current insurance cards. Additionally, in order to be treated at Ironwood Dermatology, you must present your or the guarantor’s driver’s license or photo ID.
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Referrals and Authorizations
If insurance referrals and/or authorizations are required, it is the patient’s and primary care physician’s responsibility to provide that authorization. We will be unable to obtain these for you at the time of visit.
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Payment For Copays, Products or Self Pay Procedures

Payment is to be made at time of service and may be made by cash, check, VISA, or MasterCard.

Telephone Calls
Our office telephones are very busy. You will occasionally be asked to hold for a brief period. Please be patient. Should you need to speak with a doctor, follow the prompts on our telephone system’s auto-attendant. Your call will be returned as soon as possible. Please inform the receptionist if your problem is urgent.
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Full Body Exam
To ensure the best dermatological care, we strongly encourage our patients to have a full body exam at least annually. If that exam cannot be performed at the initial visit due to the time needed to address your primary concerns, please be sure to schedule an appointment as soon as possible for that express purpose.
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Minors
Because treatment cannot be provided without consent, ALL MINORS must be accompanied by a parent or legal guardian to sign the appropriate consent form.
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Emergencies
If you have a dermatological emergency during office hours, please call first so that you can receive treatment as promptly as possible. After regular office hours, call the main office number at 520-618-1630, where you will be transferred to the answering service that directs your call to the on-call physician.
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Insurance and Financial Policies

Understanding your financial responsibility is an essential component in establishing and maintaining a strong patient/practice relationship. In order to achieve this we offer the following information regarding our insurance and financial policies.

Fees
Should you have any concerns regarding our fees, please speak with an insurance specialist, our Billing Office Manager or the Executive Administrator.

Contracted Insurance Plans
• Aetna
• Blue Cross Blue Shield
• Cigna PPO
• Coventry
• HealthNet
• Humana
• Medicare
• PacifiCare
• TriCare Standard 
• TriCare For Life 
• United HealthCare

**Please contact your insurance carrier to verify whether or not your Ironwood Dermatology provider participates with your insurance. If you do not have your insurance card or if insurance cannot be verified, you are responsible for the full balance at the time services are rendered.

Non-Contracted Commercial Insurance Carriers
Ironwood Dermatology will file your "out of network" insurance claim as a courtesy. You will want to confirm with your insurance carrier that you have an "out of network" benefit, and how that benefit affects deductible, coinsurance and your financial responsibility. Outstanding balances will be billed to the patient as "due and payable" 30 days after the claim is filed.

Medicare
Ironwood Dermatology files claims and accepts assignment on Medicare. We are happy to file all secondary and supplemental claims as a courtesy. In the case of non-contracted secondary carriers, the balance will become patient responsibility 30 days after that claim is filed. If required by your secondary carrier, you will need to obtain referral or authorization prior to your appointment.

Medicaid/AHCCCS
Because Ironwood Dermatology is not contracted with any AHCCCS/Medicaid plans, and, due to certain regulatory restrictions regarding the billing of patients, we are not able to treat patients covered under those plans. Ironwood Dermatology does not submit primary, secondary or supplemental claims for AHCCCS/Medicaid. If the patient does not disclose coverage under these plans they still have full financial responsibility to Ironwood Dermatology for any services rendered.

Private Pay Patients
Payment is due in full at the time of service. However, we may not be able to assign a final fee for procedures that necessitate the processing of pathology. In such cases, a deposit of $250.00 is required at the time of service. Following the reading of pathology, a final fee can be determined. A statement will then be generated and sent to the patient or guarantor for any remaining balance. Payment is due upon receipt.

Elective Procedures Considered Not Medically Necessary
For elective procedures, you may be asked to sign a waiver acknowledging you have been informed that Medicare or your insurance carrier does not cover those particular services and you are solely responsible for payment. Payment is due at time of service for non-covered services.

Cosmetic Procedure Deposits
Cosmetic and elective procedures may require a deposit or payment in full to hold that appointment slot. Full payment is expected at the time of service. Please be aware that a missed appointment can result in forfeiture of all or a portion of your deposit.

Pathology Fees
The physicians of Ironwood Dermatology are highly skilled in dermatopathology and frequently perform microscopic slide interpretation of their patients’ tissue specimens. In those instances, patients or their insurance carriers will receive a bill from the anatomical lab that prepares the slides and another bill from the Ironwood Dermatology physician for interpretation.

Depending upon specific factors, your physician may send the tissue specimen to an outside reference lab for both slide processing and interpretation. Patients or their insurance carriers will likely receive a single bill from an outside reference lab in this instance.
Sometimes an additional dermatopathology consultation is required for the wellbeing of the patient. Ironwood Dermatology physicians reserve the right to send their patient’s tissue specimens to the most qualified dermatopathologist of his or her choosing to perform a consultation. There will be an additional bill for this service that may or may not be covered by the patient’s insurance carrier.

Returned Check Fees
Any returned check from the bank for non-payment shall result in the patient’s or guarantor’s account being assessed a $30.00 fee per check returned.

Collection Fees
Delinquent accounts referred for outside collection will be assessed a $25 collection fee.
Guarantor is responsible for any applicable statutory interest and finance charges associated with collection.

Minor Patients
The patient registration form must be signed by the parent or legal guardian accompanying the minor at the first appointment. If the parent or legal guardian is not available for the first appointment, we require a notarized Medical Power of Attorney (POA) from the parent or legal guardian to be submitted prior to the appointment, naming an authorized adult and listing permissions given to that adult. If the Practice does not have this on hand at the time of the appointment, your appointment may be cancelled.That guarantor ultimately bears the legal responsibility for payment. We are unable to know the financial responsibilities of divorced parents. We will look to the adult accompanying the minor for payment.
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Missed Appointments
Please be aware there is a high demand for dermatology appointments and a cost to the practice for “no shows.” Appointments not cancelled within 24 hours are “missed appointments.” At this time, there will be a No Show fee assessed to your account for missed appointments. Please see the No Show/ Late Cancellation Policy above. If you continue to miss appointments, you may be dismissed from the practice.
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Dermatological Conditions Treated at Ironwood Dermatology

The physicians of Ironwood Dermatology excel in the diagnosis, medical care and surgical management of:
• Diseases and disorders of the skin, hair, nails, veins and nearby tissues
• Benign growths and malignant skin cancers
• Aging and sun-damaged skin
• Cosmetic improvement of the skin

Annual Skin Cancer Screening Exams
The physicians of Ironwood Dermatology urge patients to undergo an annual skin cancer screening examination. Skin cancer is the most common form of cancer in the United States. With early detection and proper treatment, skin cancer is highly curable.
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Skin Cancer Treatment Options
If a biopsy reveals skin cancer, your dermatologist will discuss treatment options. Treatment for skin cancer varies according to the type, location, extent, aggressiveness of the cancer, and the patient's general health. The goals of treatment for skin cancer are to remove all of the cancer, reduce the chance of recurrence, preserve healthy skin tissue, and minimize scarring after surgery.
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Thank you for choosing Ironwood Dermatology

The healthcare professionals of Ironwood Dermatology have unique qualifications and experience in the use of a wide variety of surgical and non-surgical methods of treating the skin and preventing skin problems. Moreover, they care about your appearance and want to help you to look good and feel good at any stage in life.