Patient Forms & Information
PATIENT FORMS
Use the links below to access a pdf version of the patient forms. The pdf will open in a new tab from where you can print or save it by clicking on the appropriate icon.
–RELEASE OF PATIENT INFORMATION
CONSENT FOR THE RELEASE OF PATIENT INFORMATION
Medical records can take as long as 2 weeks to complete.
-SURGICAL CARE AND INFORMATION
Below is for both Excision & MOHS procedures.
LASER AND SKIN WOUND CARE INFORMATION
EXCISIONAL SURGERY PREOPERATIVE INSTRUCTIONS
-NEW PATIENT FORMS
-AUTHORIZATION TO TREAT A MINOR
AUTHORIZATION FOR CONSENT TO TREAT A MINOR
-RIGHT TO RECEIVE A GOOD FAITH ESTIMATE OF EXPECTED CHARGES
Under the law, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your healthcare provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
Please download the forms and either take a photo of them or just email them to the office. If unable to email please mail them to the main office
Use the links above to access a pdf version of the patient form. The pdf will open in a new tab from where you can print or save it by moving your mouse cursor to the bottom right of your screen and clicking on the appropriate icon.
Insurance & Payment
We are a participating provider with many insurance companies and will gladly submit your claims for you.
We ask that you pay any deductible, co-insurance, or copay at the time the service is provided.
For your convenience, we accept MasterCard, Visa, Discover, American Express, cash and checks.
Prescription Refills
Please allow 48 hours for all prescription refills. When requesting a refill on your prescription, please have your medication information and the pharmacy phone number available for the office assistant. A review of your medical record by the physician will be required before refills are approved and occasionally it may be necessary for you to return to the office for a re-evaluation of your condition.
Indications For Skin Surgery
Dermatologists cite three reasons for performing skin surgery:
1. To prevent or provide early control of the disease.
2. To improve the skin’s appearance by removing growths, discolorations, or damaged skin caused by aging, sunlight, or disease.
3. To establish a definite diagnosis.
A change in a nevus (mole) or an unexplained growth can indicate a serious problem. A dermatologist should be seen if a nevus or skin lesion becomes larger, changes color or develops an irregular border.
Large nevi that are present at birth have a higher rate of cancerous change, which may necessitate excision. Extensive and potentially disfiguring surgery can often be averted by prompt surgical removal, by specialized freezing, or by treatment with chemicals applied to the diseased tissue.
© Copyright 1984, revised 1987, 1999 American Academy of Dermatology
Improving The Skin's Appearance
Many blemishes that occur on the skin, such as age or brown spots, birthmarks, nevi (moles), warts, wrinkles, and scars, can be eliminated or at least improved by an appropriate dermatological surgical procedure.
Age or brown spots are large freckles that develop on the face, back, and chest, as well as on sun-exposed areas. They can be minimized by using sunscreen and respond well to treatment with chemical peeling, cryosurgery, or laser surgery.
Birthmarks are areas of red-brown color that come in all sizes and shapes and can occur all over the body. Most are flush with the skin’s surface, but a few are raised. Port wine stains are deep wine-colored, and the VPL or pulsed dye laser is the preferred form of treatment if they are treated. Strawberry vascular birthmarks will often increase in size in the early months of life but usually spontaneously disappear by the age of six or so. Oral medicines can be used to diminish the strawberry birthmarks if they become disabling.
Nevi (moles) are common skin growths that are usually small and tan or brownish, are sometimes raised, and may occasionally change shape or color. Dermatologists remove nevi to improve appearance, to prevent the nevus from enlarging, or changing into cancer. Large nevi that are present at birth may have a higher rate of cancerous change. These nevi have a potential for early removal. One method of removal is surgical excision, which is done in stages over a period of several months.
Warts are caused by viruses and consist of piled-up layers of skin. They may develop at any location on the skin and may occur in people of all ages. Although topical medication, either over-the-counter or prescription, may cause the resolution of warts, some warts are resistant and require prescription medication, cryosurgery, curettage, electrosurgery, injection with chemicals, or perhaps laser therapy.
Scars resulting from acne, chickenpox, accidents, or previous surgery may be improved by laser resurfacing. With dermabrasion, the skin is frozen with a spray medication, after which a high-speed rotary abrasive wheel is used to remove the outer layers of skin and soften the irregular edges of the scar. Laser resurfacing consists of using an Erbium laser to vaporize areas of the scar. Some scars that are more depressed can be made to appear more natural using filling agents such as collagen or other types of synthetic preparations. Raised scars can be surgically leveled or flattened with steroid injections. Any operation results in some scar formation; however, a dermatologic surgeon places incisions so that the resulting scar will be minimal.
Wrinkles and deep expression lines can be partially erased with dermabrasion and laser resurfacing although the benefit does not last indefinitely. Topical chemical peeling with dilute acids can be used to minimize sun-induced wrinkles and yellowing, resulting in a more youthful appearance.
Actinic keratoses are thick, warty, rough, reddish growths that appear on the sun-exposed areas of the body. They sometimes develop into squamous cell cancer and are usually treated with cryosurgery.
Seborrheic keratosis is raised, has tan or brown growths, and is removed in a manner similar to actinic keratosis. They often become itchy and irritated by clothing. They do not turn into skin cancers.
Cysts are small closed sacs that contain fluid or solid material. Infection often necessitates that the dermatologist drains the contents. Surgical excision is the preferred method for the complete removal of the cyst.
© Copyright 1984, revised 1987, 1999 American Academy of Dermatology
In The Dermatologist’s Office – What To Expect
During the patient’s office visit, the dermatologist will discuss the person’s medical history, examine and diagnose the skin problem, explain what could happen if it is not treated, and then describe treatment options and follow-up care.
In most cases, the dermatologist will select and carry out the appropriate treatment procedure at that time. However, if the examination indicated a likelihood of cancer, the dermatologist may take a biopsy and schedule the patient for surgery at a later date.
Typically, consultations are required before cosmetic surgical procedures are performed. During the consultation, the dermatologist will explain the procedure to be done and how much discomfort, if any, will result, outline any postoperative restrictions, and answer any pertinent questions the patient may have.
The patient should always feel free to discuss any operative procedure and its cost with the physician.
© Copyright 1984, revised 1987, 1999 American Academy of Dermatology
Access our patient education library to learn more about your condition, medications, and treatments: Patient Education Library
PATIENT FORMS
Use the links below to access a pdf version of the patient forms. The pdf will open in a new tab from where you can print or save it by clicking on the appropriate icon.
–RELEASE OF PATIENT INFORMATION
CONSENT FOR THE RELEASE OF PATIENT INFORMATION
Medical records can take as long as 2 weeks to complete.
-SURGICAL CARE AND INFORMATION
Below is for both Excision & MOHS procedures.
LASER AND SKIN WOUND CARE INFORMATION
EXCISIONAL SURGERY PREOPERATIVE INSTRUCTIONS
-NEW PATIENT FORMS
-AUTHORIZATION TO TREAT A MINOR
AUTHORIZATION FOR CONSENT TO TREAT A MINOR
-RIGHT TO RECEIVE A GOOD FAITH ESTIMATE OF EXPECTED CHARGES
Under the law, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your healthcare provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
Please download the forms and either take a photo of them or just email them to the office. If unable to email please mail them to the main office
Use the links above to access a pdf version of the patient form. The pdf will open in a new tab from where you can print or save it by moving your mouse cursor to the bottom right of your screen and clicking on the appropriate icon.
INSURANCE AND PAYMENT
We are a participating provider with many insurance companies and will gladly submit your claims for you.
We ask that you pay any deductible, co-insurance, or copay at the time the service is provided.
For your convenience, we accept MasterCard, Visa, Discover, American Express, cash and checks.
PRESCRIPTION REFILLS
Please allow 48 hours for all prescription refills. When requesting a refill on your prescription, please have your medication information and the pharmacy phone number available for the office assistant. A review of your medical record by the physician will be required before refills are approved and occasionally it may be necessary for you to return to the office for a re-evaluation of your condition.
INDICATIONS FOR SKIN SURGERY
Dermatologists cite three reasons for performing skin surgery:
1. To prevent or provide early control of the disease.
2. To improve the skin’s appearance by removing growths, discolorations, or damaged skin caused by aging, sunlight, or disease.
3. To establish a definite diagnosis.
A change in a nevus (mole) or an unexplained growth can indicate a serious problem. A dermatologist should be seen if a nevus or skin lesion becomes larger, changes color or develops an irregular border.
Large nevi that are present at birth have a higher rate of cancerous change, which may necessitate excision. Extensive and potentially disfiguring surgery can often be averted by prompt surgical removal, by specialized freezing, or by treatment with chemicals applied to the diseased tissue.
© Copyright 1984, revised 1987, 1999 American Academy of Dermatology
IMPROVING THE SKIN’S APPEARANCE
Many blemishes that occur on the skin, such as age or brown spots, birthmarks, nevi (moles), warts, wrinkles, and scars, can be eliminated or at least improved by an appropriate dermatological surgical procedure.
Age or brown spots are large freckles that develop on the face, back, and chest, as well as on sun-exposed areas. They can be minimized by using sunscreen and respond well to treatment with chemical peeling, cryosurgery, or laser surgery.
Birthmarks are areas of red-brown color that come in all sizes and shapes and can occur all over the body. Most are flush with the skin’s surface, but a few are raised. Port wine stains are deep wine-colored, and the VPL or pulsed dye laser is the preferred form of treatment if they are treated. Strawberry vascular birthmarks will often increase in size in the early months of life but usually spontaneously disappear by the age of six or so. Oral medicines can be used to diminish the strawberry birthmarks if they become disabling.
Nevi (moles) are common skin growths that are usually small and tan or brownish, are sometimes raised, and may occasionally change shape or color. Dermatologists remove nevi to improve appearance, to prevent the nevus from enlarging, or changing into cancer. Large nevi that are present at birth may have a higher rate of cancerous change. These nevi have a potential for early removal. One method of removal is surgical excision, which is done in stages over a period of several months.
Warts are caused by viruses and consist of piled-up layers of skin. They may develop at any location on the skin and may occur in people of all ages. Although topical medication, either over-the-counter or prescription, may cause the resolution of warts, some warts are resistant and require prescription medication, cryosurgery, curettage, electrosurgery, injection with chemicals, or perhaps laser therapy.
Scars resulting from acne, chickenpox, accidents, or previous surgery may be improved by laser resurfacing. With dermabrasion, the skin is frozen with a spray medication, after which a high-speed rotary abrasive wheel is used to remove the outer layers of skin and soften the irregular edges of the scar. Laser resurfacing consists of using an Erbium laser to vaporize areas of the scar. Some scars that are more depressed can be made to appear more natural using filling agents such as collagen or other types of synthetic preparations. Raised scars can be surgically leveled or flattened with steroid injections. Any operation results in some scar formation; however, a dermatologic surgeon places incisions so that the resulting scar will be minimal.
Wrinkles and deep expression lines can be partially erased with dermabrasion and laser resurfacing although the benefit does not last indefinitely. Topical chemical peeling with dilute acids can be used to minimize sun-induced wrinkles and yellowing, resulting in a more youthful appearance.
Actinic keratoses are thick, warty, rough, reddish growths that appear on the sun-exposed areas of the body. They sometimes develop into squamous cell cancer and are usually treated with cryosurgery.
Seborrheic keratosis is raised, has tan or brown growths, and is removed in a manner similar to actinic keratosis. They often become itchy and irritated by clothing. They do not turn into skin cancers.
Cysts are small closed sacs that contain fluid or solid material. Infection often necessitates that the dermatologist drains the contents. Surgical excision is the preferred method for the complete removal of the cyst.
© Copyright 1984, revised 1987, 1999 American Academy of Dermatology
IN THE DERMATOLOGIST’S OFFICE – WHAT TO EXPECT
During the patient’s office visit, the dermatologist will discuss the person’s medical history, examine and diagnose the skin problem, explain what could happen if it is not treated, and then describe treatment options and follow-up care.
In most cases, the dermatologist will select and carry out the appropriate treatment procedure at that time. However, if the examination indicated a likelihood of cancer, the dermatologist may take a biopsy and schedule the patient for surgery at a later date.
Typically, consultations are required before cosmetic surgical procedures are performed. During the consultation, the dermatologist will explain the procedure to be done and how much discomfort, if any, will result, outline any postoperative restrictions, and answer any pertinent questions the patient may have.
The patient should always feel free to discuss any operative procedure and its cost with the physician.
© Copyright 1984, revised 1987, 1999 American Academy of Dermatology
PATIENT EDUCATION LIBRARY
Access our patient education library to learn more about your condition, medications, and treatments: Patient Education Library
Hilton Head Dermatology and Skin Cancer Center P.A. is always willing to assist our patients in meeting their financial obligations. We participate in many insurance networks. Several, but not all, are listed below.
If you have any questions, please contact our billing office for further information: 843.689.9200
Financial & Insurance
Tricare Prime requires prior authorization and must be obtained prior to your appointment. Any co-payments due will be collected at that time. Tricare Standard does not require prior authorization. You are responsible for any deductible, co-insurance, and/or co-payment at the time of service.
TRICARE
Tricare Prime requires prior authorization and must be obtained prior to your appointment. Any co-payments due will be collected at that time. Tricare Standard does not require prior authorization. You are responsible for any deductible, co-insurance, and/or co-payment at the time of service.
BLUE CROSS/BLUE SHIELD PPO
We are participating with BC/BS PPO plans. You are responsible for any deductible, co-insurance, and/or co-payment at the time of service.
CIGNA
We are a participating provider with many, but not all, of the CIGNA Healthcare plans. You are responsible for any deductible, co-insurance and/or co-payment at the time of service.
AETNA
We are a participating provider with many, but not all of the AETNA Healthcare plans. Please contact our office to determine if your plan is eligible.
MEDICARE SUPPLEMENTAL INSURANCE
Several plans have signed agreements with Medicare to automatically accept Medicare claims. If your insurance does not automatically accept Medicare claims, we will gladly forward all claims to secondary insurance plans.
SELF PAY / NO INSURANCE
If you do not have any insurance, we ask that payment be made when services are rendered. If you must set up a payment plan, we ask that you meet with our accounting staff prior to your visit to determine if you qualify.
COSMETIC PROCEDURE
All cosmetic procedures are payable prior to services being rendered.
CARE CREDIT
We accept Care Credit payment plans. Contact Care Credit® at www.CareCredit.com for information to determine your eligibility.
UNITED
We are a participating provider with United Healthcare plans. You are responsible for any deductible, co-insurance and/or co-payment at the time of service.
MEDICARE
We are a participating Medicare provider. You will be responsible for 20% of the Medicare allowable charge, as well as any deductible co-insurance and/or co-payment not yet met. We will collect the patient portion at the time of service.
MEDICAID
We will accept Medicaid provided you have a referral/prior authorization approval from your primary care physician prior to your appointment.
FINANCIAL POLICIES