Before you schedule your appointment, it's important to note that you do have to contact your insurance company if you plan to seek reimbursement.

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Payment receipt for your health insurance company for possible reimbursement for Breast Cancer Reconstruction tattoos ONLY. Permanent makeup and areola cosmetic tattooing are not covered by insurance. We want to emphasize that we cannot guarantee that you will be reimbursed. This is between you and your insurance company.

Breast Cancer Reconstruction patients, Read the following entirely.

The Women’s Health and Cancer Rights Act of 1998 requires insurance to cover post mastectomy reconstruction, including areola/nipple tattooing. Insurance may reimburse some of the cost of procedures but you will have to check with your insurance provider prior to your procedure to be sure this procedure is covered with your plan and if you are eligible for reimbursement. I can provide you with a receipt for POSSIBLE REIMBURSEMENT.

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Here is a link to the US Department of Labor’s details on insurance coverage for women post breast cancer.  http://www.dol.gov/ebsa/Publications/whcra.html

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Prior to scheduling an appointment for tattooing, we ask that you do the following:
Obtain an authorized letter from your surgeon who performed your reconstruction. This letter should contain the original diagnosis ICD code. It should also state that the patient is ready for tattooing and that the surgeon does not perform tattooing in their office. Additionally, it should state that the surgeon is referring the patient to an out-of-network provider who is a specialist in areola restorative tattooing.

If you would like to attempt to submit for possible reimbursement from your insurance carrier, contact your insurance company PRIOR to the procedure to be sure this is something that is covered and what they require from YOU to submit for reimbursement.

Insurance companies may require the following turned in for reimbursement (this varies per insurance carrier):

1. You will need to obtain and provide a prescription or authorization letter from your doctor that should contain your original diagnosis ICD code and applicable CPT code. Be sure to bring this with you to your appointment.
2. You will need to provide your insurance with a payment receipt for the procedure which I will provide you once completed and paid at the time of service
3. A Letter of Medical Necessity, may be required depending on the insurance carrier, this can be provided, by me upon request, for you to submit. This will be emailed to you.
4. A Billing Statement may be provided to you for submission, should you provide me with the prescription or authorization letter from your doctor with the original Diagnostic Code required.
5. If they require a prior authorization- I do not do them as I am an out-of-network provider. You may try to do it yourself but you will need the codes on your prescription from your doctor to provide to the insurance company.
 

I never guarantee your insurance company will reimburse you or to what amount. I am not a participating provider with any insurance company so, I'm considered out-of-network.  I also do not do any prior authorizations with insurance because I am not a participating provider with any insurance company.

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Pricing & Procedure
You shall bring a physician/surgeon prescription or authorization letter, if applicable, with you to your appointment for possible reimbursement. Payment due in full (by cash or card) at the time of your appointment(s). FSA/HSA methods of payment are not accepted as I am considered an out-of-network provider. Applicable Letter of Medical Necessity and Billing Statement will be emailed upon request. A receipt of payment will be provided to you once paid and the procedure is completed. Follow up visit(s) will be completed no sooner than 6-8 weeks as needed. Payment for each follow up visit(s) shall be paid the day of the procedure(s), as needed. On average, 2-3 sessions may be required for completion pending case by case basis.

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Please note, if you are required to bring physician/surgeon approval on the day of your appointment and fail to do so, you will not be seen and forfeit your deposit. Please be sure if you are unable to obtain approval, reschedule your procedure in advance to a later date until you can obtain approval.

 

It is YOUR responsibility to call and find out what they require for your plan. After your tattoo, I am happy to send in my procedure documentation and a letter written on your behalf to your insurance company if requested, to aid in your possible reimbursement.