office-policies-form – Elena Jones MD

Office Policies

Patient Consent for Use and Disclosure of Protected Health Information

I hereby acknowledge the receipt of Dr. Elena Jones Dermatology Notice of Privacy Practices. I understand that a copy of the notice can be provided to me upon request.
I understand that Dr. Elena Jones Dermatology reserves the right to change the notice and that I can obtain a copy of such changes upon request.
I know that Dr. Elena Jones Dermatology reserves the right to use and/or disclose my health information for any period of time that may reasonably be used to identify me or to administer my treatment, payment and healthcare.

Notice of Cancellation and Rescheduling Appointment Policy

If you are unable to make your scheduled appointment please call our office at 212-717-0352 at least 24 hours in advance of your scheduled appointment date, to cancel or reschedule. If you do not call 24 hours in advance you will incur a $50 cancellation fee.

Prescription Refills and Prior-Authorizations

In order to better serve you, we ask that you:

Please call for a refill when:

You notice that you have half a bottle/jar/tube
It is at least two weeks before your vacation, business trip, wedding, and any other special
- Always have your pharmacy phone number available when calling for a prescription
- Please include your pharmacy phone number when leaving a voicemail.
- Please give us at least 48 hours when returning phone calls related to prescription refills.

Our office is NOT responsible for prior authorizations. If your insurance requires prior authorization, we highly recommend using specialty pharmacies. Our office will provide a list of pharmacies that you may use. If you decide to use your local pharmacy, such as Duane Reade, Walgreens, CVS, and Rite Aid, you may be denied prescription coverage.

Consultation Fees

At Dr. Elena Jones Dermatology, we provide both Medical and Cosmetic Consultations.

Cosmetic consultations and procedures are not covered by any insurance.
1. These consultations refer to the discussion of:
  - Botox and Filler
  - Hyperpigmentation
  - Acne Scarring
  - Chemical Peels
  - Skin tightening
  - Microneedling
  - Lasers (Clear + Brilliant, Hair Removal, Fraxel, Genesis, Removal of Spider Veins)
  - Cool Sculpting
  - Microdermabrasion (Diamond Glow)
2. Medical Consultations:
  
  We are out of network with all insurance plans except for Government Issued Medicare. An itemized receipt will be provided on the day of your visit to submit to your insurance. Please contact your insurance to ensure that you have out-of-network benefits.

After three years of not being seen by a doctor in this office, you are considered to be a new patient. You will be subject to the New Patient Consultation Fees.

cosmetics consultations and procedures are not covered by any insurance.