Note: When sending files, insurance info, prior-authorizations and other paperwork it has to be images (.jpeg or .png), or otherwise must be in pdf format.
-Itemized receipt? Ready 2 weeks after the visit. Call 281-942-8001 ext 1133 
-Surprise bills? Insurance sometimes sends denial letters weeks after the visit, especially for certain rare co-insurance or restricted high deductibles plans. This result in your visit being partially covered.   This is rare but we like to make sure patients are aware of thepossibility.  Watch for the EOB insurance will send you with details. ​
Prior authorization for medication requires a special form.

1- Please print this form which is the standardized and required by the state of Texas.

2- Please fill out section I and III and include a mailing address or fax # to for your insurance.
      -Section I tells us who the form goes to, sometimes its the insurance company sometimes its the pharmacy benefits         manager.       
      -Your insurance company can tell you who that is and the contact info for that section.
       -This process can be time consuming. The clinic may charge a fee of up to 75$ to you for the additional time this will         take, outside of the regular visit time.  We do not guarantee insurance will approve the form. With dermatology,        
       insurance often does NOT approve the form - due to the elective nature of our medications/conditions.  The
       exception usually is if you have a life threatening skin condition 

When you are done - Simply upload using the buttons above and we will take care of the rest.  Prior authorization requests will be completed within 2-5 business days.  We are sorry, the process to get medications covered has become more difficult then in the past but we do not make these rules or control this process.  Please understand we will try our best.  The process can take 7-10 business days.

Prior authorization does not guarantee your insurance will agree to pay for the medication. 

Mailing Address:
Please use the Houston NORFOLK office address of
​Mosaic Dermatology Houston