Please bring the following items with you to your appointment:
- Completed New Patient Information Packet
- Current insurance card
- Photo ID or Driver’s License
- List of all current over the counter and prescription medicines
- Form of payment for Co-Pay, Deductible or Fee for Service (cash, personal check, Visa, Mastercard, HSA debit card)
- New Patient Information Packet
If you would like to send your paperwork in ahead of your appointment, please call the office for a secure HIPAA Compliant link to upload the paperwork.
- Notice of Privacy Practices
- Medical Release of Information Form
To allow us to receive or send your records at your request.
- Minor Consent Form
For minors under 18 years of age to be seen by the physician without a guardian present.
Don’t see your network?
We can still see you as a fee for service patient. Payment will be taken at the time of service. We will give you the paperwork and medical diagnosis codes for you to send to your insurance company so that you may receive your credit for your out of network deductible.
No health insurance?
We will see you fee for service and you will make payment directly to Bee Caves Dermatology at the time of service.
Out of Network Insurance or Out of Network HSA and Need to File on Your Own? Click below!
Call your insurance company to see if they require you to use their specific claim form. If so, use their specific claim form. If not, download the general Health Insurance Claim Form 1500
Complete the top portion of the form.
Be sure to include the policy ID number, patient’s date of birth, primary insured’s name and date of birth.
Attach a copy of the encounter form from our office for your date of service with the completed claim form and mail both to the claims address on your insurance card.
Note: the encounter form will be given to you at the office after your appointment and will include all necessary medical CPT and E/M codes.
If you have met your out of network deductible or do not have an out of network deductible to meet, you may receive payment from your insurance company. The payment should come directly to you. However, it is a good idea to send a letter with the forms requesting the payment be sent directly to you, not Bee Caves Dermatology.
Note: If the insurance company makes a mistake and pays Bee Caves Dermatology we will sign the payment over to you.