Financial Statement

This privacy policy sets out how Flower Mound Dermatology® uses and protects any information that you give Flower Mound Dermatology® when you use this website. Flower Mound Dermatology® is committed to ensuring that your privacy is protected. Should we ask you to provide certain information by which you can be identified when using this website, then you can be assured that it will only be used in accordance with this privacy statement. Flower Mound Dermatology® may change this policy from time to time by updating this page. You should check this page from time to time to ensure that you are happy with any changes.

Standard Payment Policy

Payment for our office visits, if out-of-network, is due at the time services are rendered. For your convenience, we accept VISA, MASTERCARD, DISCOVER, CARE CREDIT, AMERICAN EXPRESS, CASH and CHECK. We will provide you with an itemization of charges that you may submit to your insurance carrier for reimbursement of fees. For Medicare patients, our office accepts Medicare assignment and files claims with Medicare. Medicare patients are responsible for any co-insurance and deductible amounts. Medicare patients must present their Medicare card at the time of registration unless they have changed to an alternative Medicare product. In that case we would need the card sent by that insurance company. We will file secondary insurance for Medicare patients only. In you are an HMO/PPO (managed care) patient of a plan in which we participate, our office has agreed to accept the plan’s fee schedule and file the claim with your insurance company. HMO/PPO patient are responsible for co-pays and deductibles at the time of service and must present their insurance card at the time of registration. Patients are also responsible for obtaining a referral number from their primary care physician. We make every effort to seek insurance reimbursement on covered services. Filing insurance is a service we provide to you; however, insurance is a contract between you and your carrier. Once your insurance company has paid, you will receive a bill for any remaining balance on the account.

Collection Efforts

We work with you to make payment arrangements. If these efforts do not result in a resolution of the account, the account may be referred to a collection agency and the local credit bureau.

Returned Checks

A service fee of $25.00 is charged on all returned checks. You will be given the opportunity to send the total of the check plus the $25.00 fee in the form of cash, cashier’s check, or money order on a timely basis.

Missed or Cancelled Appointments

In you do not appear for your appointment, or if you cancel your appointment with less than 24 hours notice, you will be billed a $50.00 “missed appointment” fee. If the appointment was for a surgical or cosmetic procedure the fee is $100.00 without a 24 hour notice.

“Not Medically Necessary” or “Cosmetic” Procedures

Insurance companies have instituted restrictions on procedures and have designated these as “not medically necessary”. A list of procedures that commonly fall into this category are listed below:

  • Removal of benign lesions, including moles, skin tags, cherry or spider angiomas, lentigos, cysts, and seborrheic keratoses by any procedure.
  • Glycolic acid peels
  • Microdermabrasion
  • Surgery to repair a torn ear (due to earrings)
  • Sclerotherapy for leg veins
  • Destruction of blood vessels of the face
  • Botox or Fillers injections done on the face.
  • Laser Hair Removal

If you elect to continue with a procedure in this non-covered category, payment in full is required at the time the service is rendered. There is no reduction in our standard fee schedule for managed care or Medicare patients. Medicare patients will be required to sign a separate acknowledgement statement as required by Medicare guidelines. Our office does not file a claim with your insurance carrier when any of these procedures are performed.

Kind words from one of our patients…

“Dr. Perez was very nice and listened to all of my concerns. I was having acne issues and hair loss and he gave me medicine for both. He was caring and I left his office feeling relieved about my acne and hair loss. He said it most likely due to hormonal issues. The office staff is also very friendly and the office is clean and modern looking.”

– Flower Mound Resident