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.

It is estimated that about one-third of people with diabetes will have a skin disorder at some time in their lives caused by the disease. Diabetics are more susceptible to bacterial and fungal infections; allergic reactions to medications, insect bites or foods; dry itchy skin as a result of poor blood circulation; and infections from foot injuries for people with neuropathy.

There are a number of diabetes-specific skin conditions:

Acanthosis Nigricans. A slowly progressing skin condition, which turns some areas of skin, usually in the folds or creases, into dark, thick and velvet-textured skin. Acanthosis nigricans often precedes the diagnosis of diabetes. It is sometimes inherited, but is usually triggered by high insulin levels. It can occur at any age and usually strikes people who are obese. There is no treatment for the condition except to reduce insulin levels. Prescription creams may help lighten the affected area.

Diabetic Blisters. Rare blisters that appear on the hands, toes, feet or forearms that are thought to be caused by diabetic neuropathy.

Diabetic Dermopathy. Round, brown or purple scaly patches that most frequently appear on the front of the legs (most often the shins) and look like age spots. They are caused by changes in small blood vessels. Diabetic dermopathy occurs more often in people who have suffered from diabetes for decades. They are harmless, requiring no medical intervention, but they are slow to heal.

Digital Sclerosis. This condition appears as thick, waxy and tight skin on toes, fingers and hands, which can cause stiffness in the digits. Getting blood glucose levels back to normal helps alleviate this skin condition.

Disseminated Granuloma Annulare. A red or reddish-brown rash that forms a bull's eye on the skin, usually on the fingers, toes or ears. While not serious, it is advised that you talk to your dermatologist about taking steroid medications to make the rash go away.

Eruptive Xanthomatosis. A pea-like enlargement in the skin with a red halo that itches. It most frequently appears on the hands, feet, arms, legs or buttocks. It is often a response to high triglycerides. Keeping blood glucose levels in the normal range helps this condition subside.

Necrobiosis Lipoidica Diabeticorum. This condition is similar to diabetic dermopathy, but the spots are larger, fewer, deeper in the skin and have a shiny porcelain-like appearance. It is often itchy or painful. It goes through cycles of being active and inactive. It is caused by changes in collagen and fat underneath the skin. Women are three times more likely to get this condition than are men. Typically, topical steroids are used to treat necrobiosis lipoidica diabeticorum. In more severe cases, cortisone injections may be required.

Vitiligo. Vitiligo refers to the development of white patches anywhere on the skin. It usually affects areas of skin that have been exposed to sun. It also appears in body folds, near moles or at the site of previous skin injury. The condition is permanent and there is no known cure or prevention. However, there are some treatments that can be used to improve the appearance of the skin, such as steroid creams and ultraviolet light therapy.