Superbill Policy

NEW FDL DERMATOLOGY OFFICE POLICY EFFECTIVE MAY 1, 2024

FDL Dermatology is not a participating provider with any health insurance carriers. You are being provided, at your request, with the attached receipt which is intended to confirm payment for services. FDL Dermatology does not file health insurance claims on behalf of our patients. In the event your health insurance carrier has questions or requests information, FDL Dermatology is glad to respond to you as our patient, but FDL Dermatology does not communicate with your health insurance carrier directly.

The services provided by FDL Dermatology, and its health care providers, are time based and use an internal coding system that is completed on good faith estimations. The FDL Dermatology internal coding system is not intended to equate or correlate to CPT, ICD-10 or any other billing codes. This receipt is the only documentation you will receive from FDL Dermatology related to the services rendered apart from any laboratory or pathology tests or specimens that were processed and if so, you may receive a bill from Lab Corp or Derm lab. In addition, FDL Dermatology has “opted-out” does not participate in Medicare, Medicaid, or Tricare. As such, FDL Dermatology will not submit a claim for reimbursement of services to any of those governmental payors and you, as our patient, agree that you will not submit a claim to any of those governmental payors.

Patients who request a receipt with ICD-10/CPT codes for the services that were billed will be provided a receipt that has been coded by a professional coder and the cost of such coding services will be the responsibility of the patient. While the coding specialist will, to the best of his ability, associate the codes with the services provided, there is not guarantee of payment of services by your health insurance carrier or plan. Nothing in providing a receipt with codes obligates FDL to become involved with any appeals that you may choose to pursue with your health carrier or plan.

As always, we appreciate you selecting FDL Dermatology to be your health care provider and will continue to do our best to be responsive to your needs and provide you with the best quality health care services.