Making an Appointment
Office visits are by appointment only. To schedule an appointment, please call (818) 907-7546 for Sherman Oaks and (805) 497-0097 for Westlake Village, Monday through Friday between 8:30 a.m. and 5:00 p.m. or simply complete an online appointment request form. Patient registration forms may be downloaded here.
If you have not downloaded and completed our new patient forms, please arrive 15 minutes early to sign in and complete a simple registration form that includes insurance coverage information and your health history. If another doctor has referred you, please indicate his or her name and address so a report can be sent. We will take a copy of valid ID and insurance information.
Please bring with you:
- All insurance information including your card(s) with group or plan numbers
- Your ID number and mailing address for both primary and secondary insurance carriers
- A list of all prescription and non-prescription medications you are currently and have recently been prescribed
- All dermatologic medications you have been using for your skin condition
Minor Patient Appointments (Children 0-7 years old):
PLEASE NOTE: THE PARENT OR LEGAL GUARDIAN OF THE MINOR CHILD / PATIENT, MUST BE PRESENT AT THE FIRST APPOINTMENT WITH SUPPORTING IDENTIFICATION CARD AND/OR LEGAL AUTHORIZATION DOCUMENTS.
Confidential Channels of Communication:
As required by HIPAA of 1996, you have the right to request that communication concerning your personal health information, be made through confidential channels. American Skin Institute will make reasonable efforts to accommodate all reasonable requests. Some method of contact must be provided in order to contact you with the results from laboratory tests, biopsies, treatment recommendations, and payments.
Thank you for choosing American Skin Institute to be your healthcare provider. Our team of medical professionals will strive to ensure the best possible outcomes for your care. Please take the time to review our financial policies below; this information is compiled with the intent to provide you comprehensive understanding of all the financial events that could impact your visit.
- 1. Consent to Treatment: I hereby authorize American Skin Institute, Inc. to provide medical services to me, and I hereby consent to the performance of laboratory tests, diagnostics, and other medical treatments discussed with my physician.
- 2. Self Pay, Contracted & Non-Contracted Patients: If you do not have coverage by one of the insurance plans with which we are contracted, full payment for your services will be collected at the time of your visit. If at any time you are concerned about the cost of a procedure, you can speak with a representative from the billing office to better understand the costs associated with your visit. For your convenience in paying, we accept Visa, Mastercard, Discover, Care Credit, and Cash.
- 3. Insurance and Insurance Collection: American Skin Institute is contracted with Medicare and many other PPO health insurance plans; we do accept several HMO plans with a referral. Please call us to verify your HMO coverage. Based on the benefits provided by your insurance carrier, there may be a copay (office visit charge), deductible, and/or coinsurance that you are responsible for at the time of your visit. We will submit a claim to your insurance company on your behalf. Services that have been disallowed or non covered by your insurance carrier, are the responsibility of the patient. It may take your insurance company 30-60 days or longer to process your claim. Please remember that it is the patient’s responsibility to understand what services are covered under his or her insurance plan and what benefits are provided.
- 4. Billing Process: A statement will be sent to the address on file for any charges outstanding or processed payments. Our billing office will work with you to understand any of these charges as needed. If your account is not settled in a timely fashion, your account will become delinquent and may be sent to collections.
- 5. Procedures and Lab Charges: If you have a skin growth or other specimen sent to a lab for evaluation, there will be two separate charges. One charge will occur for the performance of the procedure and another will occur for a lab to examine the specimen. The lab may independently bill your insurance carrier. If you have questions regarding these fees, please contact the lab that performed the services directly. General dermatology conditions can often require multiple treatments and there can be no guarantee that a specific treatment will work for any specific condition. Multiple office visits may be required to determine an effective treatment. Each office visit will require a separate fee. If you have a copay, it must be paid at each visit per insurance company policies, we cannot waive copays or other patient financial obligations. The American Skin Institute reserves the right to send out specimens to an outside laboratory for special staining purposes, pathologic interpretation, and/or obtain a second opinion. The American Skin Institute is not responsible for any outside facility charges that be incurred.
- 6. Cosmetic Procedures: We do not bill insurance carriers for cosmetic procedures (lasers, peels, sclerotherapy, fillers, neurotoxins, Botox®, etc.) All cosmetic procedures must be paid in full prior to the procedure. Minimum cosmetic consultation fee is $150. Cosmetic consultation fee is non-refundable, and can be applied only to cosmetic procedures, not product purchases or any non-cosmetic medical services. Consult fee can be used only with the same provider seen for consultation. Payment is due at the time of service for all cosmetic procedures. Payment applies to the procedures performed at the time of service only and not to any other future treatments or packages unless specified in a written receipt at the time of payment. Cosmetic package purchases are non-refundable.
- 7. Right to refuse service: You and the clinic have the right to refuse treatment at any time for any reason.
- 8. Duration: This consent will be effective as long as you are a patient of this clinic.
- 9. Credit Card Payment Authorization: Medical charges are the responsibility of the patient. American Skin Institute will retain a credit card on file. As a courtesy to our patients, we will submit the charges for payments to your insurance company. We require credit or debit card information to be left on file for future balance billing purposes. Any remaining charges determined by American Skin Institute to be the responsibility of the patient, will be automatically charged to the credit card on file for your account. We accept all major credit cards, with the exception of American Express.
- 10. Missed Appointments and Late Cancellations: We ask that you notify us at least 24 hours in advance of any cancellations to avoid incurring a fee. Otherwise, a $75 cancellation fee will apply for appointments cancelled or rescheduled within 24 hours of the scheduled appointment time. A $150 cancellation fee will apply for missed appointments including aesthetician services. Fees are higher for lasers, cosmetic, and surgical appointments.
- 11. Non Covered Services Are Your Responsibility: We may decline to see patients for non-emergent visits if co-payments are not made at the time of the visit. In addition, please be aware that your American Skin Institute physician may provide services that may not be covered as a benefit of your specific insurance plan. Patients or Guarantors are financially responsible for any and all services provided that may not be covered by your insurance plan. It is your responsibility to know and understand your specific insurance plan and what benefits are provided. Some procedures you may undergo are best performed utilizing the equipment, safety, and comfort that can be obtained in an Ambulatory Surgery Center (ASC) setting. Please be aware that these charges are separate and apart from those fees charged by the physicians of the American Skin Institute. You should ask your insurer how your benefit plan would cover any outpatient facility/ASC charges.
- 12. Minor patients (0-17 years old): The adult accompanying a minor and the minor’s parents or guardians are responsible for full payment for services rendered. If a minor is unaccompanied, consent for treatment and payment arrangement must be provided in advance of treatment. Payment may be by pre-authorized credit card, payment on account in advance, or check or credit card present at the time of service.
Please help us maintain accurate records by informing us of any changes that need to be updated on your account (for example: address, telephone number, medical insurance, etc).
At American Skin Institute of Los Angeles, we're proud to offer Office Policies to the Los Angeles area and across Southern California. With three locations in Sherman Oaks, Beverly Hills, and Westlake Village, we are easily accessible to residents throughout the San Fernando Valley and surrounding areas for Office Policies, including: Agoura, Brentwood, Burbank, Calabasas, Camarillo, Chatsworth, Encino, Glendale, Granada Hills, Hollywood, Los Angeles, Mission Hills, Moorpark, North Hollywood, Simi Valley, Tarzana, Thousand Oaks, Valley Glen, Westwood, Woodland Hills