Medical Derm

A Cash-Pay Model is a model in which patients pay the clinic directly for their medical care. Radiance Rx is no longer contracted with medical insurance companies; therefore, the clinic does not bill insurance companies or Medicare. This model allows for no hidden fees, no surprise bills, no denial of coverage, no co-pays or insurance cards. We can still see patients for the same medical needs as before, but we will no longer accept health insurance for those visits. Instead, patients will pay for services rendered (in full) at the time of their appointment.  

This decision has not been an easy one, but it comes as a result of our desire to provide the best possible service and medical care to our patients. Unfortunately, the complexity, uncertainty, administrative burden, increasing copays/deductibles, and dwindling reimbursements associated with insurance have continued to compound over the years and are challenging that goal. In transitioning to a Cash-pay model, we can maintain an uncompromisingly high standard of care without being restricted by insurance company rules. With this transition, we can better focus on each patient’s overall experience rather than spending resources jumping through administrative hurtles and we feel that this will inspire a stronger doctor-patient relationship.  Healthcare providers at Cash-pay clinics can see fewer patients and make all decisions based on medical need, enabling them to provide the best patient experience possible.   

Patients with High Deductibles will often benefit from paying cash since, most of the time, the cash price is lower than what the cost would be towards their deductible.

Moving forward, patients will pay Radiance Rx directly for their care.  For those with private insurance, upon request, we may provide you with your visit note and receipt to submit to your insurance company for reimbursement. Not all insurance companies allow reimbursement for services. It is the responsibility of the patient to check with their insurance carrier regarding reimbursement and address any questions with them directly. Radiance Rx will not serve as liaison between patients and insurance companies. 

For those patients with Medicaid or Medicare, you cannot be reimbursed by Medicaid, Medicare or any supplemental insurance for any services rendered at Radiance Rx and we will not bill Medicare for any of our services. You will be asked to sign a private contract with Radiance Rx acknowledging that Medicare, Tricare, Medicaid or other government insurance programs cannot and will not be billed for services provided.

Absolutely! Since these are not paid directly to the practice, you can choose to use your insurance for pathology, labs, and outside prescriptions. Similarly to our policy with office visits, Radiance Rx will not serve as liaison between patients and insurance companies. 

Medication Prior Authorizations: Radiance Rx dispenses some medications in the office.  If you require a prescription that we do not offer, or you choose to utilize your private insurance, we will provide you with a written prescription or send one directly to your Pharmacy.  Please note that if your insurance requires a prior authorization (PA) we will NOT fill out any Medication PA Forms.  We will make every effort to send your prescription to a Pharmacy that will obtain a PA on your behalf, but if you request your prescription to be sent to a Pharmacy that does not obtain them for you, then you will most likely pay the full rate of your prescription to your Pharmacy.  Please contact your insurance company for more information. 

Pathology: We will not submit your insurance information for any specimen that is sent out for additional testing to TriPoint Diagnostics.  You may contact TriPoint Diagnostics at 919-237-1432 to either submit your insurance information or accept their self-pay rate.  In many cases, their self-pay rate for the testing will be 1/3 of the cost of what is billed to insurance.  They will be able to provide you with their pricing, so please contact them directly.

Labs: We will not submit your insurance information for any specimen that is sent out for additional testing to Labcorp.  You may contact Labcorp at 800-845-6167 to either submit your insurance information or accept their self-pay rate.  In many cases, their self-pay rate for the testing will be a lower cost than what is billed to insurance.  They will be able to provide you with their pricing, so please contact them directly.

Most patients can choose to submit their own medical claims to their health insurance company, but we will be considered “OUT OF NETWORK” so we will not bill insurance or act as a liaison with insurance companies on patients’ behalf. Radiance Rx makes no representation that you will be reimbursed for these claims. We recommend that you check with your insurance company before submitting any claims. 

We can provide you a clinical procedure note and/or receipt so you can submit your out-of-network reimbursement/claims for the major insurance carriers but it will be your responsibility to check with your insurance carrier regarding reimbursement and address any questions with them directly. There is no charge for a receipt or procedure note if requested at the time of your visit. If requested after the visit, there is a $10 Charge Per Appointment. Please allow 3 business days for us to provide finalized procedure notes via your email address on file. 

At this time, patients will not be able to submit any claims to United Healthcare for reimbursement of any services rendered.

Those insured by Medicare, Medicaid, Tricare, or other government programs, cannot submit claims for reimbursement.

You can still pay using your Health Savings Account cards (HSA), Flex Spending Account cards (FSA), or Care Credit for non-cosmetic services.  If you require a receipt, you may ask for one at the time of service or retrieve it from your patient portal.

Yes, FMLA or other similar forms are available for a $20 fee per form. Please allow up to 5 business days for processing.

With the Cash-pay model, we offer patients price transparency, which is often lacking with insurance. As detailed above, pricing is based off of an office visit and any add-on procedures or any surgical procedures scheduled as a follow up. Please note that prices are subject to change without notice.

For most patients, the treatment of acne starts with an Office Visit so that a clinician can assess specific concerns and determine the best course of treatment. In many cases, a series of Deep Cleanse treatments (similar to our former “Acne Surg” treatments) and occasional Office Visits to monitor progress is recommended. Deep Cleanse treatments are scheduled separately with our experienced estheticians and do not include a visit with a mid-level provider. Deep Cleanse Treatments are considered a cosmetic service and cannot be submitted to insurance for reimbursement. These treatments are available for the face, back or chest and are priced at $85 each.

Some patients require medication for treatment of acne. In those cases, typically, you will see a clinician for a follow up Office Visit after 8 weeks of being on a Topical Medication and after 12 weeks if you are on Topical and Oral Medication combined. Please note, that this is an estimate and will depend on each individual.