Insurance +Prices + How to file with your Medicare Advantage

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We are happy to see ANY patient regardless of insurance and will file with ANY insurance plans even if out of network. 

See our prices below if you are out of network or self-pay. 

NOTE ON OUT OF NETWORK PLANS: If your plan is out-of-network with us we ask that you pay at the time of service, and we will file with your insurance. Your insurance will then send payment directly to you based on the out-of-network benefits with your plan. See fee schedules below for typical costs. 

We are currently in-network with: 

BlueCross BlueShield PPO & Health Select Plans

Humana PPO 

Medicare  (but  please  read  below  on  this)

I  AM NO  LONGER  IN NETWORK  WITH  UNITED.  No  matter  what  the  United  reps  say  on  the  phone,  they  are  wrong. 

A  NOTE ON MEDICARE and MEDICARE ADVANTAGE PLANS:  

Dr. Dano is  a  Medicare  provider  but  does not accept assignment on most Medicare claims  due to sequestration of  physician  payments  by  the  government, the, administrative costs and continued  cuts to physician payments every year. They  are  calling  for  another  3% cut  to  reimbursement  for  2025.  🤕

WHAT  THIS  MEANS  FOR  YOU:  

Medicare patients pay the Medicare Limiting Charge (this is about 15% above the regular Medicare fee schedule) at the time of service, we file the claim within one week, and you will receive reimbursement directly from Medicare within 3 weeks. 

Your secondary that covers the part Medicare does not pick up may take two more weeks. 

Dr. Dano or any of her team members can tell you the cost/limiting fee before anything is done so there are no surprises. 

DEPENDING ON YOUR PLAN YOU WILL RECIEVE MOST OF WHAT YOU PAY BUT MAYBE NOT ALL. 

Worst case scenario:  you get 83% back of what you paid. Example: you pay $100 you get back $83. 

This is way less than most copays on commercial plans and way way way less than people pay for hair cuts and vet  bills.  

Medicare should forward your claim to your secondary insurance for payment. You do need to make sure you have this Medigap Option activated with Medicare for this to happen though. 

⚠️I  AM  NOT IN NETWORK  WITH ANY MEDICARE ADVANTAGE PLAN.   I  HAVE NEVER  HAD  A  CONTRACT  WITH  UNITED  MEDICARE  ADVANTAGE  PLAN--  EVER!

**Make sure you call your Advantage Plan Member Service number  on  your card to  confirm  that  you have out of  network benefits  on  UNASSIGNED claims  if you want to get reimbursed  for  your  visit. **

I file claims electronically for patients except for United Advantage plans.  

I  was  instructed by a United Rep that they require patients to file their own claims  on  paper.  

-Easy steps  to file a claim with United:  

Here is link with more details and how to file a United claim:

 https://www.uhc.com/member-resources/how-to-submit-a-claim

-We  will  give you the paperwork necessary to file your claim  the day of your visit. 

 If  you use  the  link  to  file electronically  you will  need  to  upload  these  documents with your claim.  

- Call  the  member  service number and get the address of where to mail your claim If you prefer to mail your claim.  

-You  mail the paperwork,  claim form to  that  address.  

-They  process  claim and send you the payment usually within three weeks of mailing.  

-EASY!

IF  there are any issues with your United claim  please do  not call  us or have  the United rep call  us.  

You  should call the insurance rep that sold you  the insurance plan  and they  can discuss with United.  

I  have  instructed  my  team  not  to  take  their  calls and to direct patients  back to  their  insurance  to settle  this.  

If  the  rep tells  you they  only allow doctors  to file claims, the doctor is  in network or they  only  pay  doctors  this  is wrong,  get  their  name  and  ask  for  supervisor  until  you  get  someone  who  knows  what  they  are  talking  about.  

Remind  them  you  are  being  recorded  and  can  ask  for  that  recording.  

(See  the  baloney  we  have  to  deal with?)

Again,  Please  don't  have  the  rep  call  us.  We can't  talk to them about you or your claim due  to  privacy  laws.  

Also, we are here to care for the medical needs of our patients, not  fix  their mistakes.  

 Call  the  Texas  Department of  Insurance and  report it .    Their  help  number  is  800-252-3439.   Tell  them your  insurance  company  refuses  to reimburse  you on an out of network claim you filed.  

                                                                                    Costs if self-pay or out of network

New patient office visit:  $200 

This  includes  the  cost  for  full body skin cancer screening.  (WINK: This is less than most hair highlighting, only once a year and can save your life. END WINK)

Follow up office visit:  $130-  $175  for full body skin cancer screening. Most follow up visits are $130

(Note about office visits: I am thorough and want to take good care of you. It takes time to properly document everything in order to provide you with best care. I am still charting and reviewing notes for hours a day after you leave our office.  I can address 2-3 problems or lesions per in-office visit. My skin cancer screenings are thorough so I focus on this and would ask that you schedule another appointment if you have other problems that I can help you with. Dr. Dano)

Tangential/Shave biopsy:  $130  and  additional  path  charge  from  pathologist  of  $65  if  no  insurance  

Punch biopsy:  $160

Pathology is not included in the biopsy cost. 

There is an additional cost for the pathologist to prepare and read the slides and ranges from $85-$120 (based on rates for your insurance plan). Dr. Dano will send to the pathologist that is in network with your plan and let you know how much it usually is with that plan. If you do not have insurance, there is a rate you can discuss with Dr. Dano to keep your costs down. 

Cosmetic Consults/Office visit with Dr. Dano : same as office visit rates (because it really is an office visit and often an prescription is given for tretinoin or other topical retinoid) 

Sclerotherapy: $400  per  treatment.   It usually  takes  2-5  treatments. 

Prescription drug prices: ARE CRAZY. 

Insurance companies, pharmacy benefit managers and other players are now using your prescription as a revenue center and marking up the cost of your prescriptions. 

I will work hard to find best pricing with alternate medications or use of coupons to help you afford your care. 

This is another BIG time and work element now that factors into the time it takes me to address your problems and get you proper care.  I long for the good old days when insurance companies used to try to save us money on prescriptions. 😔

* Please call if you would like a price quote on any other service including in-network or Medicare costs*

We will also work with you to find best prices on prescriptions you may need. 

I don't believe in surprise billing or inflated medical costs. We need to change this. 

 Sincerely,  Dr. Dano