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Insurance
Patient
Registration Forms
Co-Pays
and Deductibles
Charges
Adolescent
Patients
Deposit
Policy
Cancellation
Policy
Appointment Reminders
Insurance
Your time is important to you and to us. One of
our objectives at our clinic is to get you in,
taken care of and on your way as quickly as
possible. Getting your insurance information into
us prior to your visit will avoid delays
associated with insurance verification.
Your insurance company or Medicare will only cover
procedures that are medically necessary. Check
with your doctor or our front office staff
for the cost of
procedures before you have them treated.
In some cases, we are unable to verify insurance
prior to your appointment and prior to your
checkout, or your insurance carrier will not
provide us with information on the amount of
deductibles that you have met. In these
incidences, we must collect the full amount of
your charges or your deductibles at the time of
service.
If your coverage requires a referral and you or
your insurer does not provide one at the time of
your visit, we must collect the full amount of
your charges at the time of service. Again should
a refund situation arise, we will return any
overpaid funds within 30 days from the date of
service.

Patient
Registration Forms
Another way to keep your appointment on time is to
fill out any required paperwork prior to your
first visit. Many of our patient forms can be
downloaded from our website. See
Downloads at the top of this page.

Co-pays and
Deductibles
Remember that payment for all co-pays and
deductibles is due at the time of your
appointment.
Co-pays for office visits are usually higher for
specialists versus primary-care physicians. So
check with your insurance carrier to determine if
you have a higher co-pay for specialists.
If one of our physicians performs any of the
following; injecting, curettage (scraping),
electrodessication (burning), freezing or excising
a lesion or growth, your insurance company will
consider it an office surgery or procedure. Such
outpatient surgeries and procedures are often
subject to separate co-pays and/or deductibles.
Again, check with your insurance carrier to
determine how your benefits apply.

Charges
Suspicious skin lesions are often biopsied to
determine if the growth is or is not cancerous.
There are two charges associated with biopsies.
First, our office charges for the actual biopsy
performed. Second, there is a dermatopathology lab
charge for preparing and examining the biopsy
slides under a microscope. An independent lab will
bill your insurance carrier for their fees which
are not associated with our office.
We charge separately for your office visit and any
procedure performed in our office. The office
visit covers the evaluation and management or
diagnosis of your particular condition. If a
procedure is needed to remedy the condition, you
will be informed of your treatment options and
their costs so you can make an informed decision
about having the procedure performed. In such a
case, you should expect a charge for both parts of
your visit.
Patients seeing Dr. Busselberg
for cosmetic services should be prepared to pay
the full amount of their charges at the time of
service.

Adolescent
Patients
If your child is under the age of 18, a parent or
legal guardian must accompany the child to their
first appointment. If your child arrives without a
parent or legal guardian present, their
appointment will be rescheduled.

Deposit
Policy
For cosmetic appointments, we require a $100
deposit on all sessions except consultations. No
deposit is required for medical appointments.

Cancellation Policy
In today's hectic world unplanned issues come up
for all of us. We recognize this fact, but we
respectfully request that you cancel your
scheduled appointment by phone or e-mail a minimum
of 24 hours in advance. That way the open slot can
be filled with someone needing an appointment.
For cosmetic appointments, failure to provide such
notice will result in forfeiture of the $100
deposit.
For medical appointments, if you do not cancel by
the deadline, you will be assessed a $35.00 missed
appointment fee. This fee is not covered by
insurance carriers or Medicare and will be your
responsibility to pay at the time of your next
visit. Our aim here is to open otherwise unused
appointments for our patients, not to collect
missed appointment fees. Your cooperation and
consideration are appreciated as we institute this
new policy.

Appointment
Reminders
As a courtesy to our clients, we call to remind
you two days in advance of your appointment. We
will call you between 6 and 8 p.m. at your primary
contact number (usually home) to remind you of
your upcoming appointment.
If
we have your on-line address on file, we
may also confirm your
appointment by e-mail.

Click here to
schedule an appointment for a FREE
CONSULTATION.
North
Houston Plastic
Surgery
and Vein
Center
18955
Memorial
North,
Ste. 490
Humble TX
77338
713-589-4863
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