Our team of professionals and staff believe that informed patients are better equipped to make decisions regarding their health and well-being. For your personal use, we have created an extensive patient library covering an array of educational topics, which can be found on the side of each page. Browse through these diagnoses and treatments to learn more about topics of interest to you. On this specific page we will also try to answer some of the most common questions we get from our patients regarding office visits, billing and insurances.

As always, you can contact our office with any additional questions or concerns you might have! 

One of the most frequently asked questions we receive is "Can you help me with my statement from the insurance company?"  So let's decipher these complicated statements.

EOB

How Physicians refer to your Explanation of Benefits (the statement from the insurance company regarding your doctor's visit).

Account Number

Your account number represents your number with the doctor that is assigned to you at your first visit.

Claim Number

Every claim is assigned a claim number, if you need to contact your insurance company it's helpful to have this number (will save you some time).

Date of Service

The date you saw your doctor.

Procedure Number

Here is where it gets tricky.  Every office visit is assigned a CPT code or numerical value.  Without giving everyone a billing lesson these generally run from 1 to 5 as in 99243, 99244, 99245 or 99213, 99214, 99215.  You may also see "surgical" codes here.  Whenever a physician treats you in the office whether by freezing, excising, scraping or removing, these codes fall under the "surgical" category.  

Units of Service

For example, if you had multiple Actinic Keratosis treated by liquid nitrogen you may see the first procedure number 17000 (first lesion destruction) and then you might see 17003 (4) units (second through fifth lesion destruction).  We have to code this way it's the law.

Billed Amount

The billed amount is just the amount the physician billed.  It is not the amount your coinsurance or deductible will be based on.  The doctor is required by both federal and state laws and by the contract with the insurance company to write off or adjust any amount over the "allowed amount."

Allowed Amount

This is the amount the insurance company determines the physician should charge for the procedure code.  

Contractual Adjustment Amount

This is the amount the physician must write off on primary insurance ONLY (physicians are not required to write off secondary or tertiary adjustments).

Deductible

The amount that you must pay out of pocket before the insurance company will start to pay your claims.  The physician is still required to write off the contractual adjustment even if you haven't met your deductible. 

Co-Pay

This can be the set amount you must pay at every visit and it can range from $5.00 to 75.00 or more.  This column also includes co-insurance, which represents percentage after the adjustment is made that is your responsibility.  Depending on your contract this can be 10% to 50% of the allowed charges.

Amount Paid

This is the amount that was sent to the doctor on your behalf. Also, notes at the bottom will explain why something was not allowed or why the insurance company is only paying a portion of the allowed charges and not all of them.

Additional Info

There should be a phone number on your explanation of benefits if you have any questions regarding the claim or why it was processed the way it was. Don't be afraid to contact your insurance company, sometimes an insurance company will process a claim "out of network" and the physician is "in network." If this error occurs, it will generally cost you more money.  However, insurance companies will often reprocess the claim if the original claim was processed in error.

It is also worth noting here that you choose your plan and your insurance company and your network.  The physician is not there with you guiding you during this process and that is the way it should be.  However, the physician has limited control over the terms you set with your insurance company - they are contractually prohibited from writing off co-pays or deductibles.  It is against the law for a physician to bill a procedure or office visit in a specific way only so that it may be covered by your insurance company.  They must bill for exactly what happened and when it happened.

Because of the ultraviolet radiation it emits, the sun is inherently dangerous to human skin. In fact, the American Academy of Dermatology stipulates that there is no safe way to tan. Tanning is the skin's natural response to damage from the sun. Additionally, the Environmental Protection Agency proclaims that everybody, regardless of race or ethnicity, is subject to the potential adverse effects of overexposure to the sun. That's why everyone needs to protect their skin from the sun every day.

How We Burn

When ultraviolet light penetrates the epidermis it stimulates melanin, the substance responsible for skin pigmentation. Up to a point, the melanin absorbs dangerous UV rays before they do serious damage. Melanin increases in response to sun exposure, which is what causes the skin to tan. This is a sign of skin damage, not health. Sunburns develop when the UV exposure is greater than the skin's natural ability to protect against it.

Sunscreens and Sunblocks

The sun emits two types of ultraviolet (UV) rays that are harmful to human skin. UVA rays penetrate deep into the dermis and lead to wrinkles, age spots and skin cancers. UVB rays are responsible for causing sunburn, cataracts and immune system damage. Melanoma is thought to be associated with severe UVB sunburns that occur before the age of 20.

Sunscreens absorb ultraviolet light so that it doesn't reach the skin. Look for sunscreens with the active ingredients PABA, benzophenones, cinnamates or salicylates. Sunblocks literally block the UV rays instead of absorbing them. Key active ingredients for sunblock success are titanium oxide and zinc oxide.

There is no sunscreen or sunblock that works 100%. The U.S. Food and Drug Administration regulates the manufacture and promotion of sunscreens. Sunscreens are given a SPF (Sun Protection Factor) number that indicates how long a person can remain in the sun without burning. It is recommended that people use products with a SPF of 15 or greater. Sunscreens are not generally recommended for infants six months old or younger. Infants should be kept in the shade as much as possible and should be dressed in protective clothing to prevent any skin exposure and damage.

There is no such thing as "all-day protection" or "waterproof" sunscreen. No matter what the SPF number, sunscreens need to be re-applied every 2 to 3 hours. Products that claim to be "waterproof" can only protect against sunburn up to 80 minutes in the water. Products labeled "water resistant" can only protect against sunburn up to 40 minutes in the water.

Even in the worst weather, 80% of the sun's UV rays can pass through the clouds. Additionally, sand reflects 25% of the sun's UV rays and snow reflects 80% of the sun's UV rays. That's why sunscreen needs to be worn every day and in every type of weather and climate. The sun's intensity is also impacted by altitude (the higher the altitude the greater the sun exposure), time of year (summer months) and location (the closer to the Equator, the greater the sun exposure).

Protecting Yourself From Sun Exposure

  • Look for sunscreens that use the term "broad spectrum" because they protect against both UVA and UVB rays.
  • Choose a sunscreen with a minimum SPF rating of 15.
  • Apply sunscreen 15 to 30 minutes before you head out into the sun to give it time to seep into the skin.
  • Apply sunscreens liberally. Use at least one ounce to cover the entire body.
  • Use a lip balm with SPF 15 or greater to protect the lips from sun damage.
  • Re-apply sunscreen immediately after going into water or sweating.
  • Re-apply sunscreen every 2 to 3 hours.
  • Use sunscreen every day regardless of the weather.
  • Wear sunglasses to protect the eyes from UV rays.
  • Wear wide-brimmed hats and protective clothing to limit skin exposure to the sun.
  • Stay in the shade whenever possible.
  • Avoid using tanning beds.

Treating a Sunburn

If you experience a sunburn, get out of the sun and cover the exposed skin as soon as possible. A sunburn will begin to appear within 4 to 6 hours after getting out of the sun and will fully appear within 12 to 24 hours. Mild burns cause redness and some peeling after a few days. They can be treated with cold compresses on the damaged area, cool baths, moisturizers to prevent dryness and over-the-counter hydrocortisone creams to relieve any pain or itching. It is also important to drink plenty of fluids when you experience any type of sunburn.

More serious burns lead to blisters, which can be painful. It is important not to rupture blisters as this slows down the natural healing process and may lead to infection. You may want to cover blisters with gauze to keep them clean. Stay out of the sun until your skin has fully healed. In the most severe cases, oral steroids may be prescribed to prevent or eliminate infection along with pain-relieving medication.