Billing FAQs

To take the mystery out of billing, we've created a section that answers most questions you may have.

Billing FAQs

Q: How much will it cost to see the dermatologist?

A:  The cost of your visit with your dermatologist will vary depending on the type of visit and scope of treatment involved.  You can expect to be charged for an office visit which entails a discussion with the doctor for the reason for the visit, an exam of the area involved and a brief to more extensive history of the nature of your concern.  Any test and/or procedure that may be performed during this encounter will be billed at an additional charge(s).   Should you request additional information at the time of your visit or before an upcoming procedure/surgery, our Patient Advocate is available to provide a benefit check and discuss your potential out of pocket costs. For more information, please call 503-223-3104 and ask to speak to our Patient Advocate.

Q:  How do you decide how much to charge?

A:  Each office visit, test, and surgical procedure is assigned a corresponding code (called CPT codes) developed by the American Medical Association (AMA). These codes are used by ALL insurance plans, including Medicare, to process your medical claim. Each code is assigned a relative value developed by HCFA based on medical expertise to perform service, geographic location, operating cost, and liability.  The practice obtains these codes annually and adjusts our fees accordingly so we are competitive and in line with other dermatologist in the Portland area.

Q:  Will my doctor discuss fees with me during my visit?

A:  The physicians at the PDC focus on practicing good medicine.  They will recommend treatments based on what is best for the condition you are presenting.  In most cases, the physicians are not aware of the fees as they don’t want it to be a conflict of interest when discussing the best course of medical treatment for you.  

Q: How can I know how much the visit will cost me if I have any tests and procedures?

A: Be familiar with your health insurance benefits.  Know how much your deductible/co-insurance or co-pay is in advance.  Ask your doctor what codes he/she is going to submit to your insurance plan and bring them to the Patient Advocate desk.  The Patient Advocate will give you the cost of the codes before leaving the clinic. With this knowledge you can anticipate your out of pocket expenses before your receive your bill. 

Q:  Why didn’t my insurance company cover my visit?

A:  All insurance companies have the same disclaimer: “Coverage is not a guarantee of payment”.  The term ‘covered’ is different than that of ‘payment’. ‘Covered’ when referring to medical services means that your insurance is going to allow the service(s) received and will process your claim according to your specific plan benefits.  Reasons for non-payment include but are not limited to: non-covered service, deductible, co-insurance or cost share, co-pay, plan exclusion, etc.  As an example, often times the office visit will be allowed and paid by the insurance plan but the procedure performed that same day is applied to the deductible. Given the number of insurance companies and the numerous networks and benefit packages it is not possible for us to know exactly what your benefits are.  Questions regarding your specific benefits are better directed to your health insurance plan. 

Q:  What is a deductible?  What is co-insurance or cost share?

A:  A deductible is a fixed amount you agree with your health insurance plan to pay out of pocket each year for covered (allowed) health care costs before they begin to pay.  For example, if you have a $1000 deductible, you will be responsible for paying for the first $1000 in healthcare expenses out of pocket before your insurance company begins to pay. After the deductible has been satisfied there may also be an amount due from you called a co-insurance or cost share amount. This term refers to an amount you may be required to pay as your cost share for certain covered services. This amount is usually calculated as a percentage.

Q: What if I am unable to pay after insurance has processed my claim?

A: We accept all major credit cards.  We also have interest free payment plans available to assist you in budgeting for your health care cost.  We are committed to working with you so that you can receive the high quality health care you deserve.   

Q1:  The doctor spent 10 minutes with me and squirted some liquid on my wart.  I feel the charge is too high considering the treatment didn’t even work.  

Q2:  The doctor sprayed my actinic keratosis for half a second – why is it so expensive?

A1-2:  All of our doctors are board certified dermatologists with over 100 years combined experience in their field.  Given the expertise there are some conditions that are easily diagnosed and treated.  The fee is not based on time alone and takes into consideration the doctor’s expertise and skill, risk factors, supplies and resources required to perform the procedure.  Warts in particular are caused by a virus of which there is no known cure.  Whether warts are treated or not they may go away and then reappear.  It may take multiple treatments before you see any change.

Q:  Why am I being charged for pathology from your office and from somewhere else?

A: In order to provide optimum service to all of our patients there may be times it is necessary for the doctor to send the specimen(s) to an outside dermatopathologist if there is a question about the diagnosis.  In coding as created by the AMA, all pathology has two parts – the Technical Component and the Professional Component.  The slide(s) is prepped in our office and then sent out for interpretation.  A report is generated by the outside dermatopathologist which is then sent back to your doctor.  PDC will charge for the preparation of the slide(s) called the Technical Component.  The outside dermatopathologist will charge for the interpretation and report, called the Professional Component.

Q:  The doctor removed one lesion from my back.  Why am I being charged for another surgery to repair it?  Why is it not one charge?

A:  There are two parts to this type of procedure – the removal of the lesion and the repair.  The type of removal chosen is dependent on several factors such as size, location and diagnosis (benign or malignant).  The type of repair functions similarly.  The procedure is required to be billed in two parts (removal and repair) because each has specific criteria to meet per CPT coding guidelines.

Q:  What is Mohs and what will I be charged to have this surgery?

A:  The fee range for Mohs is from $2000 to $9000.  The procedure consists of two parts – the removal of the cancer and the repair of the wound.

The fee for Mohs is determined by the following:

  • The number of stages it will take for all of the cancer to be removed
  • The type of repair needed in order to close the wound

Note:  The above cost range is for Mohs surgery ONLY.  It does not include potential fees for:

  • Exam and consultation (office visit) same day as surgery  
  • Any additional procedure(s)/pathology (Example: biopsy of different site)
  • Applicable follow up care (determined by the type of care needed for repair of the wound).

Please click on Mohs Surgery for information on the procedure and what to expect.

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