Patient Information
Office Hours
Patient Forms
To save time on the day of your appointment, please fill out these forms and bring them with you:
New Patient Forms
- Patient Information
- Medical History
- Financial Policies
- Notice of Privacy Practices
- HIPAA Consent
- Patient Information( Spanish )
- Medical History ( Spanish )
- Financial Policies ( Spanish )
Authorization Forms
- Child Consent Forms
- Record Authorization From Raleigh Dermatology
- Record Authorization To Raleigh Dermatology
Patient Instructions
Insurance Information
- Advantra Freedom – Takes over for Medicare
- Aetna Medicare
- Assurant Health – Only if PHCS or MedCost is on card
- BCBS Federal
- BCBS State of NC
- BCBS out of state
- BeechStreet – Must call to verify benefits and see if we’re in network
- Benefit Planners
- Blue Medicare PPO
- PPO and HMO plans
- Coventry – Bought out First Health
- Definity Health – Only if associated w/ United HealthCare
- Empire Plan (BCBS)
- Evercare
- Medicare Advantage plans (PPO and HMO)
- Evergreen
- Medicare Advantage plans (PPO and HMO)
- Golden Rule – Only if associated w/ United HealthCare
- Great West
- GWH (Cigna) – Must have GWH on card; Takes over for Great West Ins.
- Humana ChoiceCare
- Humana Gold Choice
- Mamsi – Only if associated w/ United HealthCare
- Mail Handlers (Coventry)
- MedCost Preferred
- Medica
- Medicare
- Medicare Advantage Programs – PPO and HMO
- Medicare Railroad
- Medicare supplemental – PPO and HMO
- MPA- Medical Partners of America
- Multiplan – Includes various insurance plans, including Cigna (out of network benefits)
- NPPN
- OneNet – Only if associated w/ United HealthCare
- Oxford Health – Only if associated w/ United HealthCare Choice Plus Network
- PHCS- Private Healthcare System
- Principal PPO
- Pyramid – Takes over for Medicare
- Secure Horizons – HMO Plans need to have Authorization
- Security Choice Classic – Only if card says “A Medicare Advantage Private Fee For Service Plan”
- Sterling Option 1 – Only if PPO plan; No HMO plans
- UMR
- Unicare – Only if card says “A Medicare Advantage Private Fee For Service Plan”
- United HealthCare
- Cigna – HMO and PPO
- Aetna – HMO and PPO
- Medicare Complete – HMO and PPO
- Wellpath – HMO and PPO
Insurance Not Accepted
- Humana one
- Tricare
- Duke Select (Wellpath)
- NC Health Choice
- Medicaid - Some HMO plans
