Wilshire Aesthetics

Your initial visit

On the day of your first appointment please remember to bring three things with you:
  • your insurance card
  • your valid Driver's License
  • your credit card ( see below for explanation )
If you have any questions about this policy please call us at (323) 936-1245 ext. 0 and speak with our reception desk.

If you want to get a head start and save time, please click here to print and complete your registration forms prior to your first appointment.

Thanks!

Why we require your credit card:

We are not a provider for any insurance carrier, except Medicare and Aetna PPO.  Please note that we are not a provider for any HMOs, including Aetna HMO.
 
As a courtesy to you, we will bill your insurance (except HMOs) for any non-cosmetic dermatology appointment.  Your insurance carrier has 45 days to process the claim and send payment to us.
 
If your insurance carrier either denies the payment or does not respond, we will bill your credit card for the balance of the invoice.  We will not send out an invoice, however, we will send out notification of the amount that was charged to your credit card.  You, not your insurance carrier, are solely responsible for payment, in full, of all fees.
 
In the event that you do not have, or are unwilling to provide us with your credit card information, then you will be considered a Cash Patient and you must pay for all treatments at the time of service.


Helpful forms to complete before you arrive! 

EVERYTHING you need for your 1st visit.

Click here to download all 7 forms you'll need to complete on your first visit.

New Patient Registration Form

Collects your name, contact information, and other important data.

Financial-Billing Policy When We are NOT in Your Provider's Network

Our billing policy is easy and straight-forward.

Consent Form

In order to keep medical expenses as low as possible, it is our policy to use "arbitration" rather than litigation when settling disagreements.

Credit Card Authorization Form

For your convenience, we will bill your insurance carrier [ except for HMO Plans ]. If your insurance carrier refuses to pay for your treatment, we will charge the outstanding amount to your credit card. We understand that some people prefer not to provide their credit card. For those patients, it is necessary for you to be considered a "cash patient" and pay for your medical treatment when you receive it.

Patient Bill of Rights

We're dedicated to providing the best care possible and we've documented our commitment.

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