Accepted Insurance Plans
Please download, print, and fill out this form. Bring to your first visit to expedite your entry into the office. Also bring insurance card and driver’s license (or government ID).New Patient Form
Please complete the Yearly Patient Update Form and bring to your appointment along with your current insurance card. Also use this form when you have updates or changes.Yearly Patient Update Form
To schedule an appointment, please call our office between 8:30am to 4:30pm, Monday through Friday. At that time, we will ask you to explain the nature of your visit so that we may allow the appropriate amount of time for your appointment.
Cancellation and Missed Appointments
If, for any reason, you cannot keep your scheduled appointment, please call 410-821-SKIN (7546) with at least 24 hours notice. You are welcome to send us a fax (410-821-7576) canceling your appointment if we cannot be reached by phone. We reserve the right to charge for missed appointments or appointments cancelled with less than 24 hours notice. If a patient misses two consecutive appointments (no shows), you may be notified and advised to find another practice to serve your dermatologic needs.
We respect the time of all our patients. We strive to stay on schedule so that you do not have to wait. If you are delayed and arrive late for your appointment, you may be asked to wait or reschedule your appointment.
Financial Policy & Agreement
Thank you for selecting Simmons-O’Brien and Orlinsky, LLC as your healthcare provider. Our commitment is to provide the very best healthcare to our patients. The responsibility for payment of fees for these services is the direct obligation of the patient. Any financial payment you may receive from private insurance or government agencies is a matter strictly between you and the insurance carrier or government agency.
You must realize that your health benefit plan is an arrangement between you, the enrollee and the insurance company. While we will try to be helpful, your health benefit plan determines your coverage, any requirements for prior authorizations or referrals and establishes the limit on your coverage for medical services. We cannot know the benefits and exclusions of each patient’s policy. It is the patient’s responsibility to know and understand his/her coverage and benefits.
Billing Your Insurance Carrier
This practice will invoice you and participating insurers. All fees not covered by participating insurers will be the patient’s responsibility.
Please be sure that we have your most current demographic and insurance information at all times. It is your responsibility to provide us with this information. As soon as your information changes, notify us in writing immediately, so we can make the appropriate changes in our billing system and continue your care.
Bills From Diagnostic Laboratories
If your medical care requires blood work, a culture or a biopsy, the specimen is sent to an outside laboratory for analysis. When this occurs you may receive a separate bill from that laboratory. Any questions related to these bills will need to be directed to the billing entity.
Past Due Accounts
Accounts are considered past due after 30 days. After 90 days past due, you may be asked to leave the Practice. If your check is returned from the bank, you will be billed a $50.00 service charge.