537 Stanton Christiana Rd Newark, DE 19713 (302) 633-7550 HOME ABOUT MEET OUR DOCTORS SPECIALS PATIENT INFO CONTACT BLOG BILLING Patient Info Paperwork The following forms can be downloaded to your computer and printed prior to your visit. By filling out these forms ahead of time, you will save a significant amount of time during your visit. Please be prepared to provide this information to our office along with your current medical insurance information and your driver’s license or picture ID. If you have any questions when filling out these forms, please do the best you can and our staff will assist you with your questions on the day of your visit. Forms for Dermatologists: Forms for Dr. Christopher Conti: Forms for Plastic Surgeons: Forms for Aestheticians/Spa: Payment In order to partake in our automatic billing please complete the following form and drop off, mail or email it (billing@premierdermde.com) Insurance Medical Request/Release Forms Participating Insurance Companies: Aetna Aetna Medicare PPO Aetna Medicare HMO – REQUIRES REFERRAL Amerihealth Caritas Delaware Blue Cross Blue Shield of Delaware Cigna Highmark BCBS of Delaware Highmark Health Options Medicaid (Delaware) Medicare Medicare RR NCPPPO/PHCS Network- Insurance card will display network logo United Healthcare PPO United Healthcare HMO- REQUIRES REFERRALS United Healthcare Medicare Solutions Tricare Prime- REFERRAL RECOMMENDED Tricare Select Tricare for Life For questions regarding insurance companies we participate with please contact our Business Department at 302-633-7550 Denise: (ext 229), denise.drolet@premierdermde.com Michelle: (ext 455), michelle.williams@premierdermde.com Geraldine: (ext 429 ), geraldine.markowski@premierdermde.com Samantha (ext 445), samantha.blankenship@premierdermde.com Premier Dermatology & Cosmetic Surgery Proud Member of What Our Clients Say Previous “I have had great experiences here. The staff has been excellent . And they have been very Professional . I tell everyone that needs anything done to go to Premier!” Jeff H. “Premier Dermatology has a elegant and professional atmosphere that will cater to whatever your needs are. There are a wide range of treatments and services to choose from. With a friendly staff that will fit you in with the best of the best. I highly recommend Premier!” Misty R. “When it comes to Premier Dermatology everything about their services are top notch! As soon as you walk through there door you are surrounded by friendly and professional staff. This place is amazing and I always highly recommend them!” Jenna M. Next We have two locations in Delaware: Newark & Middletown Areas of Service Cosmetic Surgery Dermatology Skin Care Products Menu Home About Meet Our Doctors Specials Patient Info Contact Blog Billing Call Email CONTACT US ©2021 Premier Dermatology Digital Marketing and Web Development by Viamark and Red Shark Digital