Patient Resources

Forms and Downloads

Patient Demographic Information Form
Medical History Form
Medical Records Release Form

Websites explaining dermatologic conditions

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Cancellation & No Show Fees

Please note, there is a $35 no show and cancellation fee if your appointment is not cancelled within 24 hours of your appointment.

Billing

For billing questions, please contact our contracted billing company QMACS at 1-866-544-5201. Please have your patient account number handy or include it in your email so we can assist you better.

Insurance and Payments

Payments
Co-payments and deductibles are due at the time of your visit. Per federal law, you must have your insurance card and photo ID at each visit. If you have questions, please call (614) 898-7546 to speak with a billing associate or manager prior to your appointment.

You are responsible for all costs not covered by insurance. For out-of-pocket expenses, including deductibles, co-insurance and co-payments, we accept Visa, MasterCard and Discover credit cards, as well as personal checks and cash.

Plans we accept include but are not limited to:

AETNA
AETNA GOLDEN MEDICARE
AMERIBEN
ANTHEM
ASSURANT HEALTH
BEECH STREET
BENESIGHT
BUSINESS ADMIN CONSULTANTS
CNA PARTNERS
CENTRAL BENEFITS
CIGNA
CORESOURCE
DIRECT CARE AMERICA
EMERALD HEALTH
EV BENEFITS
EVERCARE
FIRST HEALTH

FORTIS BENEFITS
GEHA
GENERAL AMERICAN
GOLDEN RULE
GREAT WEST
HARRINGTON BENEFITS
HEALTH REACH
HUMANA
KLAIS & CO
MAILHANDLERS
MEDBEN
MEDICAL MUTUAL
MEDICARE/RAILROAD MEDICARE
MEDICARE COMPLETE
MEDIGOLD PPO
MERITAIN HEALTH
MUTUAL OF OMAHA

NATIONWIDE
NGS
OHIO HEALTH CHOICE
OHIO HEALTH GROUP
OHIO HEALTHY
OPTIMA HEALTH
PHCS
PPOM FLORA
PRIMARYHEALTH SERVICES
PRINCIPAL MUTUAL LIFE
PRUDENTIAL
TRICARE/TRICARE FOR LIFE (SECONDARY)
UNICARE
UMR
UHC, EMPIRE, RIVERVALLEY, ALL SAVER,
NAVIGATE, AARP,
MCR COMPLETE

PLEASE NOTE: COSC IS NOT A PROVIDER
FOR ANY MEDICAID OR EXCHANGE PRODUCT.
**ANYTHING WITH THE WORDS CATASTROPHIC, BRONZE, SILVER, GOLD OR PLATINIUM IN THE NAME**

Plans That Require a Referral:

AETNA-HMO, MEDICARE HMO, SELECT, EPO
TRICARE PRIME
UHC MEDICARE ADVANTAGE
HUMANA HMO GOLD PLUS
UHC MCR COMPLETE HMO
UHC ALL SAVER
UHC NAVIGATE

AETNA MANAGED CHOICE POS & QUALITY POINT OF SERVICE (QPOS) REFERRRAL URGED FOR MAX BENEFITS

Plans We Are NOT Providers For:

AETNA TRINITY
ANTHEM BCBS ARIZONA PREFERRED NETWORK HMO
ANY HMO MEDICAID
BUREAU OF HANDICAPPED CHILDREN
CARESOURCE/JUST FOR ME
CHAMPUS
MEDIGOLD HMO
MOLINA

MT CARMEL
UNISON
ASSURANT HEALTH (THROUGH THE STATE EXCHANGE)
MEDICAL MUTUAL PATHWAY
MEDICAL HEALTH
COVENTRY
COORDINATED
ANTHEM PATHWAY

MOLINA MARKETPLACE
PARAMOUNT HEALTH CARE
PREMIER HEALTH PLAN
SUMMACARE INDIVIDUAL
KAISER FOUNDATION HEALTH PLAN OF OHIO
AULTCARE
ANY MY CARE OHIO
MOLINA MARKET PLACE
UHC COMMUNITY PLAN & COMPASS

If you have a question about whether or not we accept your insurance plan, please call our office at (614) 898-7546. Our patient accounts team will be more than happy to verify coverage before we make your appointment.

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