The accomplished Pittsburgh plastic surgery providers of Aestique® Plastic Surgery and their medical staff have provided the following forms and resources for your education and preparation for consultation, your surgical procedure and more. Please complete and bring along with you to your appointment.
Plastic Surgery Forms
For office appointments, all patients are required to print off and complete the Registration, Medical History, HIPAA and Consent to Communicate forms. (additional forms may be required depending on what you are being seen for). You can either fax them to (724) 832-7415, e-mail them to firstname.lastname@example.org or bring them along with you the day of your appointment. Be sure to bring along 2 forms of ID.
Aestique Plastic Surgical Associates Policies
Aesthetic Consultation/Cancellation Policy
Your appointment time is reserved especially for you. There is a $100 fee for all aesthetic consultations. A deposit of $50.00 will be required upon scheduling your appointment. On the day of your visit, the remaining $50.00 balance will be due upon check in. This fee will be forfeited if you do not show for your appointment or cancel/reschedule within a 24 hour period.
This policy has been implemented as an added benefit to our patients. We acknowledge that your time is just as valuable as ours. This policy will help ensure that we can assist in getting you scheduled in a timely manner, utilizing both yours and the doctors’ time most effectively.
We recommend that you arrive at least 15 minutes prior to your first scheduled appointment. This will allow ample time to complete the registration process to ensure you have your the allotted time to spend with the Surgeon. When you arrive for your visit, you will notice that we have a few extra safety measures in place to help keep everyone safe. You must wear a mask or a facial covering while you are in our facility. We ask that you come alone to your appointments or limit it to one guest, if medically necessary. Please refrain from bringing any children under the age of 18 with you. We will ask you a series of questions upon arrival in order to complete a COVID 19 screening as well as taking your temperature with a touchless temporal thermometer. Hand sanitizer is readily available at all desks.
We ask that cell phones & electronic devices are turned off during your appointment.
For the comfort of all our clients, Aestique is a smoke-free facility.
As a courtesy, we will file your claims for you with your primary and secondary insurance carriers. Please remember that insurance is a contract between you, the patient, and your insurance company. Ultimately you are responsible for payment in full. Some procedures require pre-authorization from your insurance carrier. Our office is pleased to provide this service following your consultation. *Please note that we typically know what procedures insurance companies consider medically necessary and we are keenly aware of criteria heathcare providers require. Further, we do not attempt to get unjustified surgical procedures approved.
The authorization process may take several weeks. Surgery will not be scheduled until the authorization is received. Co-payments and deductibles (if applicable) are due at the time you see the doctor and will be collected upon check in.
We accept cash, cashier’s checks, personal checks and the following major credit cards:
- Visa and MasterCard
- American Express
Aestique refers its customers to the following quality lenders for their financing:
Dollar Bank Loan Center – Click here for more details and use promo code 0029-3799.
Care Credit – Follow the simple steps to get pre-approved before your visit by clicking here.
Your Rights and Protections Against Surprise Medical Bills
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pockets costs, such as a copayment, coinsurance and/or a deductible. You may have other costs or have to pay the difference between the amount your health plan pays for the items and services and the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facility that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charges for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count towards your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care- like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
If you have an emergency medical condition and get emergency services from an out of network provider or facility, the most you will have to pay the provider or facility is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition unless you give written consent and give up your protections not to be balance billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most you will have to pay these providers is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balanced billed.
If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.
You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
Contact the Pennsylvania Insurance Department at www.insurance.pa.gov/nosurprise or by phone at 1-877-881-6388 or TTY/TTD: 717-783-3898 if you have difficulty finding a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have these protections:
- You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
- Your health plan generally must:
- Cover emergency services without requiring you to get approval for services in advance (prior authorization).
- Cover emergency services by out-of-network providers.
- Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
- Count any amount you pay for emergency services or out-of-network services towards your deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed, you may contact the Pennsylvania Insurance Department at www.insurance.pa.gov/nosurprise or by phone at 1-877-881-6388 or TTY/TTD: 717-783-3898. Visit www.insurance.pa.gov/nosurprises for more information about your rights under federal and state law. You may also visit https://www.cms.gov/nosurprises for information from the federal government.
For Your Reference
At Aestique Plastic Surgical Associates, we believe the best doctor-patient relationship is made through communication and detailed information. Aestique has adapted an innovative software system called TouchMD. TouchMD changes the way patients interact with their doctors, turning any wait time you encounter in the exam room into an opportunity to learn more about our facility and procedures and treatments offered.
What TouchMD Does
Endorsed by the American Society for Aesthetic Plastic Surgery (ASAPS), TouchMD is designed to improve the relationship between doctor and patient. It is changing the way patients experience consultations by making them interactive through touch screen technology.
Before a consultation, TouchMD allows patients sitting in the exam room or viewing from the comfort of their own home to view information on specific topics and procedures, enhancing their education and providing them a fuller understanding of the process. By using TouchMD, patients can more efficiently communicate their thoughts, questions, and goals with the surgeons.
The TouchMD technology also helps our doctors provide patients with a clear understanding of what each procedure and treatment entails. This gives us the ability to use interactive and visual tools to aid in the communication and explanation of treatment plan options, how treatments will be performed, risks and benefits, and other factors.
What You Can Expect from TouchMD
Through the TouchMD technology you can expect a broader understanding of Aestique and a variety of topics thanks to educational videos that you can explore, all by way of a state-of-the-art touch-screen. Some of the topics include:
Since TouchMD is customized to our practice, there is biographical and credential information on our plastic surgeons, as well as introductions to other members of our team you will meet along the way and will be caring for you. You will also be able to see our facility and learn the history of Aestique.
Topics Video Gallery
Most procedures have helpful video descriptions that you can view on the TouchMD screen. This ranges from skin care, non-invasive injections and plastic and reconstructive surgical procedures.
Our photo gallery will show you before and after pictures of the procedures and treatments we offer for both our plastic & reconstructive surgical procedures as well as our medical spa treatments.
Personal TouchMD Web Portal
You can access the TouchMD content before or after your consultation through TouchMD’s personal web portal, myTouchMD. By creating an account, you can view information on specific topics and procedures, gaining a fuller understanding of the process to more efficiently communicate your thoughts, questions, and goals with the surgeons.
To create your personal myTouchMD account, click on the button below. The Doctors Registration Code is: AESTIQUE.
If you have any questions about TouchMD, please e-mail email@example.com and we will promptly respond.
Attention Breast Augmentation Patients
You will love this! When you come in for a consultation with Dr. Theodore Lazzaro, we suggest bringing a sports bra or some sort of bra that does not have padding or underwire to try on different sizes of implants. We also recommend you bring a form-fitting shirt to see what you look like with clothing on. With the TouchMD technology, we are able to take photos of you with the different size implants you are considering and upload them to your personal TouchMD chart. myTouchMD enables you to go home and view the photos again or share with friends and loved ones!