Patient Resources

New Patient Forms

Please download and print the “New Patient Form” and "Health History Form" from the links below. After completing these forms, they may be mailed, faxed or hand delivered at the time of your office visit.

Out-of-Town Cosmetic Patients

Out-of-town cosmetic patients stay at Quality Inn

Accommodations for Out-of-Town Cosmetic Patients

For our out-of-town cosmetic patients, Spokane Plastic Surgeons will gladly arrange for a complimentary stay for two for the first night after surgery at nearby Quality Inn Oakwood Hotel. Please contact us so we can make the arrangements for you.


While estimated costs can be given for some cosmetic procedures, a more exact quote will be provided for you at the time of your office consultation to include surgeon’s fee, operating room and anesthesia. Quotes cannot be given for hospital or other charges outside of our office.

Cosmetic surgery is not covered under insurance programs and prepayment is required two weeks before surgery. We accept VISA, MasterCard, and Discover Card for pre-payment of these procedures. Also available is the ASPS endorsed financing through CareCredit. Simply use this link to apply online or phone them at (800) 365-8295 and use Spokane Plastic Surgeons (Dr. Lynn D. Derby) for the referral name. They will be able to discuss their credit line application, estimated monthly payments and APR.

Credit cards accepted  CareCredit accepted

Contracted Insurances

Aetna & MedicareSM Plan
Amerigroup Programs
Asuris & Regence (Most Programs)
Cigna Healthcare
Coordinated Care Programs
Department of Labor & Industries (L&I)
First Choice Health Network (FCHN)
Great West Healthcare
Group Health Cooperative & MedAdvantage
Medicaid & Healthy Options (HCA)
Medicare & Medicare Railroad
Molina Programs
Providence Health Plan
Premera Blue Cross (Most Blue Shield Programs)
Uniform Medical Plan (UMP)
United Healthcare Services

Healthcare Coverage and Your Insurance

We, at Spokane Plastic Surgeons, are genuinely concerned about your understanding of our fees and the payment allowances of your healthcare coverage or insurance. If you have any questions, please speak to one of our insurance or billing specialists and we would be happy to clarify any concerns you may have.

Physician’s Fees

The surgeon’s fee is the same whether done in the hospital, our office operating suite or examining room.

Facility Fees

With all surgical procedures, there is a separate fee for the facility’s room charge. This may be a hospital operating room charge, an office or ambulatory surgery center room charge or supplies (if done in the examining room).

Ancillary Fees

Many procedures have some fees for other specialist services, which are separate charges. These may be for anesthesia, pathology, radiology or physical therapy. We do not bill for or control these fees and cannot quote these charges.

Referrals, Co-Pays, and Preauthorizations

It is your responsibility to ensure that your insurance referral, medical records, x-rays and insurance coverage is available and eligible for date of service. Your insurance card, coupon, claim number, or proof of coverage must accompany you at every visit. All co-payments must be paid at time of visit to be seen.

It is your responsibility to check with your insurance carrier about your deductibles and out-of-pocket costs. Any balance payments after insurance is payable upon receipt of statement. For special payment considerations, please discuss with our billing department prior to services rendered.

Most major procedures have a 90-day global follow-up included in surgery. After that date, referrals, co-pays and charges will be applied.

Our office routinely obtains preauthorization from insurances prior to surgery and will contact you if we need your assistance.

Reconstructive consultations, which are not covered under insurance programs, are subject to an office visit fee, which can be applied to surgery within one year’s time.

Liability claims will not be submitted to your health insurance and need to be prepaid.

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