Insurance

DLC Insurance Contracts
Your insurance coverage is a contract between you and the insurance company. It is the patient’s responsibility to know her/his insurance benefits. Our team is not responsible for researching your plan benefits.

Dermatology & Laser Center of Chapel Hill (DLC) is an in-network provider with these contracted insurance plans:

  • Blue Cross and Blue Shield of North Carolina (BCBS) plans
    • We do not accept Blue Value or Blue Home
  • Cigna Healthcare
    • We do not accept Cigna Connect Individual and Family Plan (IFP)
  • Medicare
    • We do not accept Aetna Medicare 
    • Medicare does not cover an annual skin check, but it will cover an evaluation and/or testing if you or your provider discover something that needs further evaluation.
    • Medicare does not cover treatment of benign lesions.
    • Medicare does not cover screening for skin cancer in asymptomatic people. https://www.medicare.gov/
    • Sometimes Medicare is not the primary payer. Please inform us if this is the case.
  • United Healthcare
    • United Healthcare HMO requires a referral from your Primary Care Provider (PCP)
  • United Health Care Medicare Advantage (which includes AARP)

If you have other insurance we do not accept, we will collect your payment at time of service.

Referrals
If your insurance plan requires a prior authorization or a referral, please obtain this from your referring Primary Care Provider (PCP). You are responsible for obtaining your insurance prior authorizations. If the DLC provider orders a test or referral to another specialist, please allow 5 days for our clinical staff to process your referral.

HMO vs PPO
With a Health Maintenance Organization (HMO) plan, you pick one primary care provider. All your health care services go through that doctor. That means you will need to obtain your own referral before you can see any other health care professional, except in an emergency. Visits to health care professionals outside of your network typically aren’t covered by your insurance. It is not our responsibility to facilitate your referrals.

For example, if you get a skin rash, you wouldn’t go straight to a dermatologist. You would first go to your primary care physician, who’d examine you. If your primary care provider can’t help you, he or she may refer you to a dermatologist. It’s the PCP responsibility to refer you to an in-network specialist.

Coordinating all your health care through your primary care provider means less paperwork and lower health care costs for everyone.

PPO Plans
Preferred Provider Organization (PPO) plans give you flexibility. You don’t need a primary care physician. You can go to any health care professional you want without a referral – inside or outside of your network.

However, staying inside your network means smaller copays and full coverage. If you choose to go outside your network, you’ll have higher out-of-pocket costs, and not all services may be covered.

How do deductibles, coinsurance and copays work?

Deductible
A deductible is the amount you pay out of pocket for health care services before your health insurance begins to pay.

How it works: If your plan’s deductible is $1,500, you’ll pay 100 percent of eligible health care expenses until the bills total $1,500. This is “meeting your deductible.” After your deductible is met, you share the cost with your plan by paying coinsurance.

Coinsurance
Coinsurance is your share of the costs of a health care service. It’s usually figured as a percentage of the amount the insurance company allows to be charged for services. You start paying coinsurance after you’ve paid your plan’s deductible.

How it works: You’ve paid $1,500 in health care expenses and met your deductible. When you go to the physician’s office, instead of paying all costs, you and your plan share the cost. For example, your plan pays 70 percent. The 30 percent you pay is your coinsurance.

Copay
A copay is a fixed amount you pay for a health care service, collected when services are rendered.  The amount can vary by the type of service.

How it works: Your insurance plan determines what your copay is for different types of services. You may have a copay before you’ve finished paying toward your deductible. You may also have a copay after you pay your deductible, and when you owe coinsurance.

Good Faith Estimate (GFE)
An estimate from a health care provider or facility for the expected costs of items or services. If you’re uninsured or not using your insurance, the provider or facility generally must give you a GFE before you get a health care service if you ask for one or if you schedule an appointment at least 3 days before you get a health care service. In certain circumstances, a provider that isn’t in your plan’s network must also give you a GFE if it wishes to charge you more than your plan’s in-network cost sharing amount.

Please contact your Insurance carrier directly for individual health care plan coverage benefits, limitations and questions.

Questions?

If you have any questions about insurance or your bill, please contact DLC:

Phone: 919-942-2922

Email: contact@dlcofchapelhill.com