As physicians, our relationship is with you, not your insurance company. Please understand that:
- Your insurance is a contract between you, your employer, and the insurance company. We are not a party to that contract. We have a separate contract with your insurance company.
- Our fees fall within the acceptable range of most companies, and therefore are covered up to the maximum allowance determined by each carrier. This applies only to companies who pay a percentage (such as 50%, or 80%) of “usual, customary, and reasonable fees” for this region. This statement does not apply to companies who reimburse based on an arbitrary "schedule of fees” that bears no relationship to the current standard and cost of care in this area.
- Not all services are covered benefits in all contracts. Some insurance companies arbitrarily select certain services they will not cover, and do not readily disclose this fact until after the service has been rendered.
- Only one procedure is done per visit. If necessary, a follow-up visit may be scheduled to discuss results.
For our HMO patients: Your insurance may require you to have a referral for every visit to Dr. Resnik. It is your responsibility to obtain your referral prior to your visit with Dr. Resnik. If you do not have your referral, your visit will be deferred until one is obtained, delaying your treatment and care.
I hereby instruct and direct my Insurance Company, to pay by electronic deposit of funds or check made out to Resnik Dermatology Aventura, P.A.
If my current policy prohibits direct payment to doctor, I hereby also instruct and direct you to make out the check to me and mail it to the address above, for the professional or medical expense benefits allowable, and otherwise payable to me under my current insurance policy as payment toward the total charges for the professional services rendered. THIS IS A DIRECT ASSIGNMENT OF MY RIGHTS AND BENEFITS UNDER THIS POLICY. This payment will not exceed my indebtedness to the above‑mentioned assignee, and I have agreed to pay, in a current manner, any balance of said professional service charges over and above this insurance payment.
- A photocopy of this assignment shall be considered as effective and valid as the original.
- I authorize Resnik Dermatology Aventura, P.A. to deposit checks received on my account.
- I also authorize the release of any information pertinent to my case to any insurance company, adjuster, or attorney involved in this case.
- I authorize doctor to initiate a complaint to the Insurance Commissioner for any reason on my behalf.
By completing this form digitally and typing my name here, I acknowledge that this is my digital signature and understand it to be as legally binding as my cursive signature.