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Provider Referral

Patient Referral

Dear providers:

Carolina’s Dermatology and Plastic Surgery is committed to providing the best care for your patients’ needs of Dermatology, Mohs Surgery, and Plastic Surgery.

If your patient needs to be seen urgently, please note that in the referral form. We will see them within 4 business days if not sooner.

BEFORE SENDING A REFERRAL:

Please see below an updated list of insurance plans that we accept.

Accepted Insurance Plans
  • Self Pay
  • Aetna
  • Aetna Medicare
  • Aither (PHCS or Multiplan)
  • Allied
  • Blue Choice (ZCC – authorization required)
  • Blue Choice ZCL
  • Blue Cross Blue Sheild PPO
  • Blue Cross Federal
  • Blue Cross State (PEBA)
  • Champ VA
  • Christian Brothers
  • Cigna
  • CWI Benefits
  • Department Of Energy/Labor (Surgeries)
  • Emblem Health (Secondary Only)
  • First Health
  • Freedom Life Ins CO
  • GEHA
  • Healthgram
  • Healthsmart
  • Medcost
  • Medicare
  • Medishare
  • Multi Plan
  • PAI
  • PHCS
  • Planned Administrator PAI
  • Prisma
  • TCC
  • Tricare East (Prime – authorization required)
  • Tricare Select
  • UHC (allsaver, golden rule, oxford, etc…)
  • UHC Medicare Advantage (All Plans)
  • UHC Navigate (Referral/Authorization may be needed)
  • UMR
  • VA – VACCN – referral required
NOT Accepted Insurance Plans
  • Allwell/Absolute Total Care Advantage (Dual Only)
  • Ambetter
  • BlueCross BlueShield with the following prefixes (CNS, CNN, PEQ, PEZ)
  • Cigna Courage Medicare
  • Clover
  • First Choice
  • Humana Medicare
  • Medicaid
  • Molina
  • NO International Plans
  • Prisma Financial Assistance Program
  • Pruitt Health Medicare Advantage
  • Select Health
  • Sentera (including PHCS and Multiplan)
  • UHC Oxford – Freedmon Life
  • United Mine Workers of America (Medicare Advantage)
  • VIP
  • Wellcare
  • Workers Comp

To refer your patient to one of our offices, simply fill out our online patient referral form.

For patients from any facility (nursing, home, assisted living, etc)

If the patient, for any reason, can not consent to any treatment by our practice, we request that the patient’s responsible party (such as relatives) fill out and sign this form before the visit.

Request Appointment

*This is a request form, not a guaranteed appointment. Upon receiving this completed form, we will contact you to confirm your actual appointment. If you need immediate assistance, please give us a call.