WELCOME TO THE FAMILY

Please arrive without wearing any makeup or tinted sunscreen as these can limit our ability to detect areas of concern.

Your arrival time on the day of your appointment will depend on whether you have been able to pre fill your medical history on the patient portal. If you have, then plan on arriving 5 minutes early. If you have not completed your medical history online, please arrive 15 minutes prior to your appointment time.

Please remember to bring your insurance cards, a credit card to put on file, and identification to your appointment. When you arrive, we will scan these into your chart, collect your copay, and provide you with a tablet to review your information and sign any consents that may have been overlooked on the patient portal.

Your appointment will begin with our nursing staff taking you to an exam room where your medical history will be verified, and a brief explanation of your dermatologic concerns will be documented. Time for this process is included in your appointment so you can expect to see a provider within 10-15 minutes after your appointment time.

Finally, you’ll get a chance to sit down and begin discussing how we can help you get the care you deserve!

Before you leave your exam room, nursing staff will schedule any necessary follow up visits, provide you a printed copy of your counseling, and send in any prescriptions. When you leave, you will only need to stop and “check out” if you had any cosmetic treatments performed in which case those services will be paid for on the day of your visit.

Any medical procedures and your office visit will be billed to insurance and an invoice will be sent to you by text with the option to pay online. You may get a notice of this option, and option to opt-out before you even leave our office for the day.

Appointment Confirmation Policy

We require all new patient appointments, surgical appointments, and cosmetic appointments to be confirmed 24 hours prior to your appointment time. We will send you text and email appointment reminders, and you can confirm your appointment via text. If you do not confirm your appointment via text, we will call you to confirm your appointment. If your appointment has not been confirmed 24 hours prior to your appointment, your appointment will be marked as a “no show” subject to our no-show policy and your time slot will be released to patients on our wait list. We apologize in advance for this strict rule.

Photograph & Credit Card on File

We do require a photograph of your face as it enhances Dr. Gaul’s clinical skills for your care! We also require a credit card on file and will notify you of your bill before charging it.

Arrival Time
If you are an established patient, please arrive 5 minutes before your scheduled appointment time so our front office staff may update your chart and collect applicable copays. If you have new insurance, please bring your new card in with you and let our staff know.
If you are a new patient and you have used the patient portal or online check in to complete your medical history, then you are fine to arrive only 5 minutes before your scheduled appointment time. Please bring copies of your insurance card and ID.
If you are a new patient and have not been able to pre-fill your medical history on the patient portal, please arrive 15 minutes prior to your scheduled appointment time. Please be sure to bring a full list of any known allergies, current and past medical conditions, and the medications you are taking (or have tried for the condition you are being seen for). If it is easier for you, you can bring your medications in with you, or take a picture of them.

Late Arrivals
Please note that arriving 15 minutes or later past your appointment time is considered late and we may have to cancel your appointment and reschedule you. We will always do our best to accommodate late arrivals whenever possible. Various factors are considered when determining if we can fit you in past your scheduled appointment time. We will look to see if there are openings in the provider’s schedule, the scheduled scope of your visit, if your medical history has been completed, etc. Please understand we never want to reschedule a late patient, but are also doing our best to be considerate of all the other patients coming in after you. We work very hard to stay on schedule and late arrivals impact every subsequent patient for the day, not just the next patient.

No Shows
Each time a patient misses an appointment without providing proper notice, another patient is prevented from receiving care. Therefore, patients who do not show up for their appointment without a call to cancel at least 24 hours before the appointment time will be considered a “no show.” From time to time we understand a call the day before may not be possible, however if it happens repeatedly we may choose to charge a “no show fee.” Commencing with the third missed appointment and continuing thereafter, Rapid City Dermatology & Mohs may charge a fee of $75.00 for all missed appointments (“no shows”). This fee is not covered by insurance and must be paid in full prior to your next appointment. Alternatively, we may refuse to allow the patient to schedule additional appointments at our clinic.

No shows for surgical appointments will be charged $250. Cosmetic fees will be charged at booking, including a $150 cosmetic consultation charge for those who are not opting for membership. The consultation fee can be applied to cosmetic treatment if booked and completed within 6 months.

Standalone Visits (Rashes, Acne, Hair Loss)
Rashes, Acne and Hair Loss, and Skin Cancer Screenings are standalone appointments. Due to the nature of these conditions, the level of history that is taken and evaluated, testing or biopsies that may be necessary and thorough discussion of medication options, risks and benefits, these types of visits cannot be combined with other visits like a skin cancer screening.

Can I “add on” or change the scope of my visit?
When we schedule appointments, we allocate only enough time to address one main issue. For example, if you schedule an annual skin cancer screening, there would not be time to also add on a rash or hair loss to the same encounter. If you need to make changes to your visit, please understand we may have to reschedule you to another day. However, we will try to accommodate the most concerning issue you have, which may be a new rash or concern, and reschedule a less pressing skin check.

Minors

A legal guardian must accompany children under the age of 18 to their initial appointment so that appropriate consents may be signed and background medical information may be authenticated. Children without a legal guardian at their initial visit will be rescheduled. For follow up visits, minors may come to visits without a parent/guardian only if we have a signed Consent to Treat Minor form on file with our office. We can email this to you upon request.

Copayments or cosmetic service fees (such as chemical peels) will be due at the time of service whether you are present or not.

The office will not call you after the encounter to review what was discussed. We are not able to call you during the encounter, although your minor is welcome to have you on the speakerphone of their own cell phone if you would like. You may request progress notes after the provider has signed off on the chart note, and all counseling provided (such as for medication regimens) will be available on the patient portal.

Guests

Please limit guests to one per patient whenever possible.

Can I wear makeup?

Please do not wear makeup to your appointments. It can interfere with our ability to evaluate your skin.

Can I ask about my spouse’s bill? About their treatment? Can I ask about my adult child’s bill? About their treatment?

HIPAA prevents us from disclosing a patient’s information to anyone who the patient has not authorized us to speak with. We know that spouses often schedule one another’s visits, or receive and pay bills for one another. Parents often schedule for adult children still living at home, and may even be the primary insured on the adult child’s insurance card.

Each time the patient comes in, we will ask the patient if we can add anyone as a HIPAA contact… and explain that this will allow us to discuss upcoming scheduled appointments, answer billing questions or discuss other matters pertaining to patient care with someone other than the patient. If we do not have permission from the patient, please understand we cannot speak with anyone but the patient about their visits, bills or care.

If you would like the patient to add you as an approved contact, please ask them to add you to their chart. Please note this is a general rule and there are some exceptions to this rule under the law.

Billing for Skin Cancer Screenings:

Dermatology visits, including skin cancer screenings, cannot be billed as “preventative medicine screenings.”

Medicare and most insurance companies specifically exclude dermatology from preventive billing codes.

While skin cancer screenings are preventative in nature, medical coding requires a comprehensive exam to evaluate and treat all chronic medical conditions for a visit to be considered preventative.

Some insurance companies indicate coverage for skin cancer screenings but require the screening to be done by a primary care physician, not a specialist.

As a result, your visit will be billed as a specialist office visit with “evaluation and management” codes, and will be subject to your specialist office visit copays and deductibles.

This billing practice is consistent across dermatology practices, not unique to our office.

We are a hybrid concierge and insurance based practice, which means we offer all of our patients concierge benefits for an annual fee of $500, separate from insurance billing for covered expenses.

Rapid City Dermatology & Mohs will provide the Patient with the following Concierge Benefits under the Program: 

• Expedited Appointments 

• Post operative wound care kit for first week after surgeries.

• Skin Care and Cosmetic Plan (if desired by patient)

• 10% off all cosmetic charges and products sold in office

• 1-2 lesions per visit that do not legally require pathology (they are not cut off) to be treated with the aim of destruction

  • Extraction of Clinically Normal Milia

  • Destruction of Clinically Normal Seborrheic Keratoses, Angiomas, Skin Tags, Sebaceous Hyperplasia

Dr. Gaul wants to practice differently, allowing more time with her patients and accommodating their last minute needs as they come up. If you have a new rash or concerning changing lesion, you shouldn’t have to suffer or wait until things escalate.

Dr. Gaul values a strong and committed relationship with her patients, and feels continuity of care makes a huge difference. She is frustrated by the denials and declining coverage and reimbursement by insurance, for the sake of practices and patients. She is committed to getting you the best medications, or finding the most affordable alternatives. This takes time. She cares about those annoying or ugly spots you hate, even though they are benign. While she does not want to commit insurance fraud for your normal growths, she looks forward to treating them more reasonably if you choose this concierge membership.

Transparent honesty will always be given regarding cosmetics. As in the past, Dr. Gaul will continue to recommend treatments outside of her practice if she feels they would give you the most benefit for reaching any goal you may have. She prides herself in building collegial relationships and seeking expertise from excellent practitioners within Rapid City and beyond.