Policies

Cancellation / No-Show Policy

Please be advised, for all appointments a 24-hour cancellation notice is required. A 48 hour notice (the prior Thursday by noon) is required for Saturday appointments.
In the event of a late cancellation or no-show, we will charge a $75 appointment cancellation fee for an office visit, $125 for a cosmetic or surgical visit.  This fee must be paid prior to making any additional appointments.

Illness Policy

We respect the choice of patients and staff to wear a mask for protection from COVID-19 and other infectious illnesses. Guests who have a fever greater than 100.4, new onset loss of smell or taste, difficulty breathing and/or cough, or are in quarantine for an exposure will be asked to reschedule their visit. A mask can be provided upon request.

Golden Rule Policy

Verbally or physically abusing one of our doctors, physician assistants, or team members will not be tolerated at Affinity Dermatology. Your appointment will be canceled and you will be asked to vacate the facility. This is for the safety and comfort of all patients, Team Members, and providers.

Firearms Policy

Affinity Dermatology supports the ongoing efforts of both individuals and groups working to prevent gun violence, and continually review our policies and procedures to ensure our clinic remains a safe environment. We require that our patients, other than authorized law enforcement personnel, do not bring firearms into our clinic.  Violation of this policy may result in dismissal from clinic and police intervention as per Sections 30.06 and 30.07 of the Texas Penal Code as follows:

Concealed Carry Notice: “Pursuant to Section 30.06, Penal Code (trespass by license holder with a concealed handgun), a person licensed under Subchapter H, Chapter 411, Government Code (handgun licensing law), may not enter this property with a concealed handgun.”

Prohibido Portar Armas De Fuego Conforme A La Sección 30.06 Del Código Penal (Traspasar Portando Armas De Fuego) Personas Con Licencia Bajo Del Sub-Capitulo H, Capitulo 411, Código De Gobierno (Ley De Portar Armas). No Deben Entrar A Esta Propiedad Portando Un Arma De Fuego Oculta.

Open Carry Notice:

Pursuant to Section 30.07, Penal Code (trespass by license holder with an openly carried handgun), a person licensed under Section H, Chapter 411, Government Code (handgun licensing law), may not enter this property with a handgun that is carried openly.”

 DE ACUERDO CON LA SECCIÓN 30.07 DEL CÓDIGO PENAL (INGRESO SIN AUTORIZACIÓN DE UN TITULAR DE UNA LICENCIA CON UNA PISTOLA A LA VISTA), UNA PERSONA CON LICENCIA SEGÚN EL SUBCAPÍTULO H, CAPÍTULO 411. CODIGO DEL GOBIERNO (LEY SOBRE LICENCIAS PARA PORTAR PISTOLAS), NO PUEDE INGRESAR A ESTA PROPIEDAD CON UNA PISTOLA A LA VISTA

Financial Policy:

1. By accepting an appointment at Affinity Dermatology, you are agreeing to the terms of this Financial Policy (or on behalf of the patient if the patient is not the responsible party)
2. PAYMENT AT TIME OF SERVICE: Payment is due in full at the time of service. Patients with outstanding balances must pay their balances in full PRIOR to scheduling another appointment or being seen for their next appointment. Balances become due upon receipt of the statement, which is delivered via mail and/or text. Patients who fail to pay their balances may face cancellation of their appointments and/or dismissal from the clinic.  Failure to receive the statement does not relieve the patient of the requirement to pay.
3. INSURANCE: Patients will be asked to present their insurance card and driver’s license to the receptionist for scanning to your chart upon check-in at the office each time they are seen for medical services. Please make it a point to bring your insurance card with you each time that you visit our office. Claims not paid within 45 days by your insurance company will become your responsibility. You will receive a statement for these services, and you will need to contact your insurance company for reimbursement.
4. As a courtesy, we attempt to verify insurance benefits prior to the visit.  However, it is ultimately the PATIENT’S responsibility to verify that this office and their provider are contracted as participating providers with their plan prior to the visit. For those patients covered by insurance plans with which we ARE participating providers, payments for all co-payments, deductibles, co-insurance amounts, and non-covered services are due at the time of service. We will file your insurance claim to the insurance company. In the event that your insurance coverage changes to a plan with which we ARE NOT participating providers, we will require payment in full at the time of service at the current self-pay rate. Your insurance policy is a contract between YOU and your insurance company. We cannot guarantee payment of your claims by your insurance company.  Any charges that are not paid by your insurance company are your responsibility. Reduction or rejection of your claim by your insurance company does not relieve the financial obligation you have incurred.
5. Any pre-certifications for procedures or testing are your responsibility. Please let us know in advance of starting any procedure if your insurance company requires this. It is also your responsibility to understand your plan and request any desired cost estimates prior to treatment. Your consent to treatment is also constitutes consent that you will pay the contracted cost for the treatment or procedure.
6. REFERRAL AUTHORIZATION/HMO Plans: patients are responsible for obtaining a proper referral from their primary care physician (PCP) prior to the visit.  If authorization is not obtained, you will be considered “self-pay” and will be responsible for the full cost of the visit and any procedures at the time of the visit.
7. MEDICARE: We accept assignment and will file insurance for our Medicare patients.  However, any calendar-year deductible amounts, up to the amount of the visit, are due at the time of service.  We will also file with any secondary insurance after payment from Medicare is received if we are contracted with your secondary plan.  If there is no secondary insurance, the patient will be billed for the remaining amount.
8. MEDICAID: We are NOT contracted with Medicaid and we are unable to accept patients who use Medicaid/CHIP as a primary form of insurance, nor are we able to accept patients who use Medicaid as a secondary plan to any other insurance product. We are also unable to accept patients who have Medicaid in any form as a cash-pay patient. This is due to contractual requirements placed upon participants and providers by the Center for Medicare and Medicaid Services. Patients who have Medicaid/CHIP as part of their insurance coverage will be directed to seek service from a covered provider.
9. INDEMNITY PATIENTS: We do not file insurance for our indemnity patients. Payment in full is expected at the time of the visit and a receipt will be provided for you to file with your insurance carrier.
10. RETURNED CHECKS: There will be a one-hundred dollar ($100) fee assess for any returned check. This fee is assessed regardless of whether the check is deposited because the bank will have already charged us a fee for the returned item.  You will subsequently receive a bill for this amount.
11. CREDIT BALANCES: If your account has a credit balance of more than $100, a refund will be mailed to you within 120 days. Other balances will be refunded upon request.
12. COLLECTIONS: Please note, if payment is not received from either you or your insurance company within 60 days from the date of service(s), your account will be considered delinquent and subject to referral to an outside collection agency. You also agree that once our account is submitted to collections, this also terminates your relationship with Affinity Dermatology for future services beginning on the date of receipt of the collections notice, with the exception of emergency care during the period of 30 days beyond receipt of collections notice. All appointments scheduled prior to and after the receipt of the collections notice will be cancelled without notice. Should the patient desire to resume care with Affinity Dermatology, the outstanding balance must already be paid, and a $125 reinstatement fee will be due at the time of scheduling another appointment. Additionally, all current and future appointments will require prepayment at the time of scheduling.
13. POLICY UPDATES: This policy may be updated or changed at any time without prior notice.
14. AUTHORIZATION AND RELEASE: I authorize the release of my medical records to determine liability for payments, treatment, or to obtain reimbursement.  I assign all medical benefits for office visits to Affinity Dermatology, PLLC. This assignment will remain in effect unless and until revoked by me in writing. A photocopy or electronically signed copy of this paperwork will have the same validity as the original.

Affinity Dermatology PLLC Privacy Policy

ONLINE PRIVACY POLICY

Last updated on April 8, 2021

This online privacy policy applies solely to information collected through our website and not to information collected offline. Please note that our practice complies with the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) with information collected online and in person.

Affinity Dermatology PLLC (Affinity Dermatology) is committed to the privacy of our visitors and patients. The following policy outlines the privacy practices for the Affinity Dermatology website (www.affinitydermatology.com).

We do not sell any customer information to any third party. Additionally, we will never provide individually identifiable customer information to any third party except as follows:

• If compelled through legal processes (including court orders, warrants, or subpoenas);
• If we find that your use of our website violates any laws or usage practices;
• Information is required to finalize a payment for services and products requested.

Personal Information

Personal information (defined as any information that identifies or can be used to identify, contact, or locate the person to whom such information pertains to) is collected through affinitydermatology.com only when voluntarily provided during a customer visit to our website, including online form submissions. Personal information collected includes name, address, telephone number, personal health information, email address, and other personal information.

How Personal Information Is Used

The information voluntarily provided through the forms on our website is used by Affinity Dermatology to respond to service requests or questions, to provide any products or services desired. Information may also be used to send reminders of future appointments you have scheduled with Affinity Dermatology. All information you provide is treated as private and confidential.

Broadly speaking, we use personal information for purposes of administering our business activities, providing customer service, and making available other product and services to our patients and prospective patients. Occasionally, we may also use the information we collect to notify you of new services and special offers we think you may find valuable. The lists used to send you product and service offers are developed and managed and designed to safeguard the security and privacy of our patients’ personal information. As a patient, you will be given the opportunity to opt out.

Updating Personal Information

If you would like to remove or modify your personal information, please contact us at contact@affinityderm.com. We will gladly and expediently comply with your request.

Disclosure to Third Parties

We do not sell, trade, or otherwise transfer to outside parties your personally identifiable information. This does not include trusted third parties who assist us in the operation of our website, conducting our business, or servicing you, in which case these people/entities are under signed agreement to not misuse or disclose information. We may also release your information when we believe such release is required to comply with the federal, state, or local laws, enforce our site policies, or protect ours or others rights, property, or safety. However, non-personally identifiable visitor information may be provided to other parties for marketing or other uses.

Cookies

Our website utilizes cookies, which are small pieces of data that may be sent to your web browser and stored on your computer. This means we collect non-personal information from website visitors including the user’s browser type, IP address, external links you clicked to reach our site, and pages you visit while viewing our website. The IP address may be stored with the personally identifiable information you provide in order to allow us to provide more finely tuned customer service both now and in the future.

The information collected by cookies may be used to understand and save your preferences, improve the performance of our website, and process transactions. Additionally, cookies may be utilized for various marketing functions. You may choose to accept or reject cookies through the configuration settings of your web browser. Cookies, which are set on your computer and used within Affinity Dermatology, will not collect personal information, financial information, confidential information, or passwords.

Affinity Dermatology may authorize third parties to collect, track, and process all non-personal information collected by cookies.

Third Party Links

Our website may contain links to third-party websites (“Third Party”) and services with which we have no affiliation. Any link or mention of a Third Party does not mean we endorse it or the quality or accuracy of information presented on it. We do not endorse or otherwise accept responsibility for the content or privacy policies of those sites. If you decide to visit any Third Party Services, you are subject to its privacy policy and practices and not this Privacy Policy. We encourage you to carefully review the legal and privacy notices of all other digital services that you visit.

Communication Opt Out

 If you wish to opt out of receiving offers directly from Affinity Dermatology, you can unsubscribe by following the opt-out instructions in the emails that we send you located at the footer of the communication.  We can be reached by postal mail at the business address, 13136 Dallas Parkway, Suite 520, Frisco, TX 75033, by email at contact@affinityderm.com, or by phone at 469.480.8100.

Data Security & Information Access

This site has certain security measures in place to protect against loss, misuse and alteration of the information under our control. We utilize a Secure Site Certificate enabling SSL encryption for your confidential information. Online servers are further protected from unauthorized electronic access by firewall technology that recognizes, reports and locks out unusual or apparently unauthorized access attempts.

Databases are regularly backed up and saved to protect against loss of information. Backup storage media and online servers are maintained in a physically secured and environmentally controlled facility with monitored physical access controlled by password, biometric and physical security measures

Access to visitor or guest information (including backup media) by staff and contractors is controlled by both policy and electronic means. Only authorized staff has access to customer data. Individual staff members may be allowed to access only certain parts of customer information as may be required to perform their job functions. All staff or contractors with any access to customer data are under signed agreement not to misuse or disclose such information to any third party except as may be required by law or job function.

We reserve the right to modify this privacy policy at any time without notice.

PRIVACY POLICY CONTACT INFORMATION:

Email: contact@affinityderm.com
Phone: (469) 480-8100