|How can I file a claim with my insurance company for out of network benefits?
Call your insurance company to see if they require you to use their specific claim form. The contact phone number is on the back of your insurance card. If so, use their specific claim form. If not, download the general Health Insurance Claim Form 1500 from this website
Complete the top portion of the form.
Be sure to include the Policy ID number, patient’s date of birth, primary insured’s name
and date of birth.
Attach a copy of the encounter form from our office for your date of service with the
completed claim form and mail both to the claims address on your insurance card.
Note : the encounter form will be given to you at the office after your appointment and
will include all necessary medical CPT and E/M codes.
If you have met your out of network deductible or do not have an out of network
deductible to meet, you may receive payment from your insurance company. The
payment should come directly to you. However, it is a good idea to send a letter with the
forms requesting the payment be sent directly to you, NOT Capitol Dermatology Associates.
Note: If the insurance company makes a mistake and pays Capitol Dermatology, we
will sign the payment over to you.