Mosaic Dermatology Houston
If you are sending an insurance card, we do need BOTH SIDES (the full front and back) of the card or the full detailed eligibility letter.  You can bring this on the day of the visit but it has to be a hard copy we can scan.  We do not accept pictures of insurance on the day of the visit.  If you uploaded front/back of insurance on our schedule website you do not need to do it again, but please upload your ID below.

Also, please send us the front of your photo ID(or that of the legal guardian if patient is under 18).  We do need the front of the ID on file to help prevent healthcare fraud.  You can bring this on the day of your visit or send it via this website in advance to allow a more efficient check in.  

No copay on card? Or a refund is pending for you?  You can also send EOB or benefits detail letters (we will need the EOB if your insurance has told you that you have met your deductible or if your card does not have a copay on it).

If you are requesting a release of records, please upload the release form and the front/back of a credit card.  All record release take 5 business days to process and have a 5$ fee.

Any other forms take 5-7 business day to process.  

For itemized receipts, charge details, or paperwork for tax reasons please call our billing office in Florida 407-875-2080 ext 2

Patient Name