(305) 864-6200Virtual ConsultVirtual ConsultBook Online

FINANCIAL POLICY

Payment is due at the time of service. We accept cash and credit cards (no checks). If you have insurance that will pay our physician directly, and which we can verify, it is still required that you pay all co-payments, deductibles, and co-insurance at the time of service. It is your responsibility to know your plan’s benefits. Payments for non-covered and insurance deemed non-medically necessary services are your responsibility. Payment for cosmetic services is your responsibility and will be discussed with you before the physician performs such service. If you are a member of an HMO or PPO that requires a referral from your primary care physician, you are responsible to bring the referral with you for your visit. If you are an established patient to the practice, this form will replace any previously signed financial policy. If a skin biopsy or such procedure is performed at today's visit, or labs are ordered, there will be a separate charge from the laboratory. Your health plan may not pay for these services, and you will be personally responsible for these services.

CANCELLATION POLICY: If you are unable to keep an appointment, it is your responsibility to cancel the appointment 24 hours in advance of the appointment time and date by calling the office. Appointments cancelled via text messaging service or email less than 24 hours in advance will also be subject to this fee. Many patients are waiting for open appointments and cancelling less than 24 hours before makes it impossible to fill these spots. If you do not notify the office at least 24 hours in advance to reschedule the appointment, you will be charged the following NO SHOW SCHEDULING FEE:

  • New patient missed office visit: $50 fee
  • Established patient missed office visit: $50 fee
  • Missed visit with our aesthetician: $50 fee
  • Missed cosmetic (Neurotoxin such as BotoxTM or DysportTM, Filler, Laser, AquagoldTM, Peel, cosmetic consultation, etc) visit: $100 fee
  • Missed surgical/Mohs appointment: $150 fee
Please note these fees ARE NOT COVERED BY YOUR INSURANCE.

We require a credit card to be kept on file for all patients to be used for all unpaid balances for services rendered now and in the future. Medical visits will first be billed to your insurance carrier. Once the claim has been processed, your card will be charged for any outstanding balance. Payments for self-pay and cosmetic services are due at the time of the office visit and charges will be placed on your credit card on file. Fees for cancellations will also be placed on your credit card on file. My signature below indicates that I hereby request payment of benefits for all medical services provided by my physician be issued directly to her. I accept full financial responsibility for all expenses incurred and agree that any portion not paid by my insurance is due and payable from me upon demand. I agree to the cancellation fees as listed above.

Name(Required)
Agree to terms(Required)

Outstanding Balance Authorization

I authorize Melissa Lazarus, MD Dermatology to charge my credit card on file for any outstanding balances.

Outstanding Balance Authorization

Authorization to Release Information

I grant authorization to release any information required to obtain payment of medical benefits to Melissa Lazarus, MD Dermatology, billing company, credit card processor, and collection agency (if required). I understand and agree to this financial policy, and my questions have been adequately answered.

Authorization to Release Information
Use this form to request a consultation.
  • This field is for validation purposes and should be left unchanged.

The information on this website is for educational purposes only. Accordingly, any information contained within should not be construed as medical advice, evaluation, or consultation and should never be considered a replacement for a formal evaluation by the physician in his/her office and related consultation. Therefore, the information and correspondence that is involved with this website does not constitute a formal doctor-patient relationship. This website should not be used as a substitute for medical help. Opinions provided here are my own and do not represent the opinions of my employer or the medical societies of which I am a member. Explanation of off-label services and/or products that are mentioned herein does not reflect an endorsement nor promotion and should not be construed as such.

Copyright © 2017 Dr. Melissa Lazarus. All Rights Reserved. 1080 Kane Concourse | Bay Harbor Islands, FL 33154 | (305) 864-6200 phone | Follow us: 
Pay Online
facebook-squareinstagram