beyond pissed.......nipple tattooing

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jikaras
jikaras Member Posts: 58
So, double mastectomy with implants in January 2009. Everything was going perfect with insurance.

I now decided that I would like to complete the process by doing the tattooing. Found someone in my area (Milwaukee, WI) that does it, but she charges $350.00 per. She requires that I pay her and then submit it to my insurance for reimbursement.

Contacted my plastic surgeon who said that my insurance doesn't cover it...Just got off the phone for 45 minutes and the final outcome was "well, what we suggest is that you go back to your plastic surgeon, because your probably going to get reconstruction done anyway, and get the nipple re-creation done then" - well, DA......you weren't listening to a thing I was saying-HAD RECONSTRUCTION DONE 2 YEARS AGO!!!! And why would I go do that, when my plastic said that it sometimes has to be done 3 times in order for the skin not to just fall apart?? Why would I have you pay for 3 more surgeries instead of just a dang $700 tattooing bill???

They won't pay, because it's all COSMETIC.........!!!!! Yeah, just what I want to do-go show my ta-ta's to everyone who asks if I have a tattoo......

Thanks for letting me vent ladies.....

Jill

Comments

  • disneyfan2008
    disneyfan2008 Member Posts: 6,583 Member
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    @Jill so sorry
    So sorry all these hassles...I"ll be thinking of you

    Denise
  • jendrey
    jendrey Member Posts: 377
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    @Jill so sorry
    So sorry all these hassles...I"ll be thinking of you

    Denise

    ...
    What type of insurance do you have? Perhaps you can appeal the descision? I'm a little confused, was it your PS that told you your insurance didn't cover it?

    There was something that the PS nurse told me wasn't covered but when I called my insurance myself I found out it was. The way it works is that the nurse had to make a prior request first before it could be covered and for whatever reason it became commonplace not to bother making a prior request.. Therefore they simply told me it wasn't covered when in fact it actually was but only if it was preapproved.

    Does that make any sense?!!

    As an aside, I wonder what those tattoo artists that are re-imbursed, I wonder how they go about it? Maybe some research by asking one of them is in order...

    Also, what state do you live in? Some states have laws pertaining to breast reconstruction where it spells out what's what.
  • dyaneb123
    dyaneb123 Member Posts: 950
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    jendrey said:

    ...
    What type of insurance do you have? Perhaps you can appeal the descision? I'm a little confused, was it your PS that told you your insurance didn't cover it?

    There was something that the PS nurse told me wasn't covered but when I called my insurance myself I found out it was. The way it works is that the nurse had to make a prior request first before it could be covered and for whatever reason it became commonplace not to bother making a prior request.. Therefore they simply told me it wasn't covered when in fact it actually was but only if it was preapproved.

    Does that make any sense?!!

    As an aside, I wonder what those tattoo artists that are re-imbursed, I wonder how they go about it? Maybe some research by asking one of them is in order...

    Also, what state do you live in? Some states have laws pertaining to breast reconstruction where it spells out what's what.

    My plastic surgeon will do
    My plastic surgeon will do my tatoo's whenever I'm ready to have them done. I just had to have the implant redone in January because rads. messed it up, but my insurance will cover the tats as part of the reconstruction. I would think your plastic surgeon would do them for you, but if not, it's still part of reconstruction...not just random cosmetic surgery...this doesn't sound right to me...ask your plastic surgeon's office.
    Dee
  • seof
    seof Member Posts: 819 Member
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    I would say call your
    I would say call your insurance company yourself. it may be that it must be pre-approved, or maybe there are specific doctors or facilities they cover or dont. If your insurance company won't cover it, maybe the Dr. could give you a discount. I was originally told my noncancerous breast recon was not covered, but after my parents helped us pay (the surgeon gave a discount) the insurance did pay after all. It certainly can be very confusing!

    Hope it all gets worked out soon. seof
  • survivorbc09
    survivorbc09 Member Posts: 4,374 Member
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    jendrey said:

    ...
    What type of insurance do you have? Perhaps you can appeal the descision? I'm a little confused, was it your PS that told you your insurance didn't cover it?

    There was something that the PS nurse told me wasn't covered but when I called my insurance myself I found out it was. The way it works is that the nurse had to make a prior request first before it could be covered and for whatever reason it became commonplace not to bother making a prior request.. Therefore they simply told me it wasn't covered when in fact it actually was but only if it was preapproved.

    Does that make any sense?!!

    As an aside, I wonder what those tattoo artists that are re-imbursed, I wonder how they go about it? Maybe some research by asking one of them is in order...

    Also, what state do you live in? Some states have laws pertaining to breast reconstruction where it spells out what's what.

    Hoping that you can get this
    Hoping that you can get this cleared up to where your insurance will pay, as, they should.


    Jan
  • pinkkari09
    pinkkari09 Member Posts: 877
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    Jill, Federal law mandates
    Jill, Federal law mandates that all insurance companies pay for "Complete" reconstruction for woman with BC. Please look into this, you should be able to get it covered. I have BCBS and they sent me a copy of the federal law and assured me I would be covered through the whole process.
    ~Kari
  • VickiSam
    VickiSam Member Posts: 9,079 Member
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    Jill, Federal law mandates
    Jill, Federal law mandates that all insurance companies pay for "Complete" reconstruction for woman with BC. Please look into this, you should be able to get it covered. I have BCBS and they sent me a copy of the federal law and assured me I would be covered through the whole process.
    ~Kari

    Kari is 100% correct .. Please check with your state
    first. Here in California .. complete reconstruction, means just that -- complete, nipples, and tattoo.

    Has your insurance lapsed? If not, please contact a case worker within your insurance group.

    Please let us know what happens.

    Be your own best advocate!!! That's my advise.

    Vicki Sam
  • jikaras
    jikaras Member Posts: 58
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    some basic updates and info
    I'm in Wisconsin - insurance is United Healthcare.

    I did call them and got the general run-around........

    I was first told by the male call center person that I spoke to, that I would need to find a plastic surgeon in my area that does the tattooing in their office. He was more than happy to supply me with a list of doctors in my area (63 of them), that I could call to inquire. I told him I was NOT going to call them, as I've already been told that there are no plastic surgeons in SE Wisconsin that do this. (this was all based on the phone conversation that I had with my PS. They have had other patients who want the same thing done as me, but found that insurance wouldn't pay. They already did the legwork).

    So, male operator then send me to another branch of their call center, and I got male operator #2.....I explained my situation, and he said I needed to talk to someone in "appeals"....

    Onto operator #3, who was female. I explained what was going on, and she said that there was nothing that she could do. She said that there were a number of things:
    #1-my insurance won't cover it - it's 'cosmetic'
    #2-I couldn't even appeal it, because a claim has never been submitted.
    #3-because my PS isn't doing it, there's nothing to file....
    #4-the cosmetic specialist who does this is licensed, but doesn't work through insurances.

    I also thought that there was some federal mandate that said everything needs to be covered, but can't find anything on the web on it. If someone could e-mail it to me, that'd be fantastic (jillkaras@yahoo.com).....

    What angered me was operator #3 telling me what I should do to get it covered (reconstruction with the nipple surgery)..... Don't tell me what I should do with my body! Needless to say, I ended the conversation with alot of swear words, yelling and crying and finally hanging up....
  • joannstar
    joannstar Member Posts: 403 Member
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    jikaras said:

    some basic updates and info
    I'm in Wisconsin - insurance is United Healthcare.

    I did call them and got the general run-around........

    I was first told by the male call center person that I spoke to, that I would need to find a plastic surgeon in my area that does the tattooing in their office. He was more than happy to supply me with a list of doctors in my area (63 of them), that I could call to inquire. I told him I was NOT going to call them, as I've already been told that there are no plastic surgeons in SE Wisconsin that do this. (this was all based on the phone conversation that I had with my PS. They have had other patients who want the same thing done as me, but found that insurance wouldn't pay. They already did the legwork).

    So, male operator then send me to another branch of their call center, and I got male operator #2.....I explained my situation, and he said I needed to talk to someone in "appeals"....

    Onto operator #3, who was female. I explained what was going on, and she said that there was nothing that she could do. She said that there were a number of things:
    #1-my insurance won't cover it - it's 'cosmetic'
    #2-I couldn't even appeal it, because a claim has never been submitted.
    #3-because my PS isn't doing it, there's nothing to file....
    #4-the cosmetic specialist who does this is licensed, but doesn't work through insurances.

    I also thought that there was some federal mandate that said everything needs to be covered, but can't find anything on the web on it. If someone could e-mail it to me, that'd be fantastic (jillkaras@yahoo.com).....

    What angered me was operator #3 telling me what I should do to get it covered (reconstruction with the nipple surgery)..... Don't tell me what I should do with my body! Needless to say, I ended the conversation with alot of swear words, yelling and crying and finally hanging up....

    Try googling
    "federal law for breast cancer" and you should be able to find it.

    http://www.plasticsurgery.org/Patients_and_Consumers/Procedures/Reconstructive_Procedures/Breast_Reconstruction/Breast_Reconstruction_Resources/1998_Federal_Breast_Reconstruction_Law.html

    Good luck!!
    JoAnn
  • jendrey
    jendrey Member Posts: 377
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    joannstar said:
    ...
    From the Wisconsin Legislature: Statures

    "609.77 Coverage of breast reconstruction. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.895 (13). History: 1997 a. 27, 237; 2001 a. 16."
    (http://legis.wisconsin.gov/statutes/Stat0609.pdf)

    632.895 (13)
    "Breast reconstruction.
    632.895(13)(a)(a) Every disability insurance policy, and every self-insured health plan that provides coverage of the surgical procedure known as a mastectomy shall provide coverage of breast reconstruction of the affected tissue incident to a mastectomy.
    (http://docs.legis.wisconsin.gov/statutes/statutes/632/VI/895/8/f/2#/statutes/statutes/632/VI/895/8/f/2)

    Also found this:
    609.01(3)
    "(3) "Limited service health organization" means a health care plan offered by an organization established under ch. 185, 611, 613 or 614 or issued a certificate of authority under ch. 618 that makes available to its enrollees, in consideration for predetermined periodic fixed payments, a limited range of health care services performed by providers participating in the plan."
    (http://docs.legis.wisconsin.gov/statutes/statutes/609/01/3)


    I suggest you to email the Attorney General of Wisconsin. (http://www.doj.state.wi.us/ag/)


    Or better yet give the Wisconsin Insurance Commissioner a call:
    OCI (Office of the Commissioner of Insurance)
    1-800-236-8517, (608) 266-0103
    •All questions and/or complaints regarding insurance companies and policies
    (http://www.doj.state.wi.us/ag/contact.asp)

    Hope this helps.
  • jendrey
    jendrey Member Posts: 377
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    jendrey said:

    ...
    From the Wisconsin Legislature: Statures

    "609.77 Coverage of breast reconstruction. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.895 (13). History: 1997 a. 27, 237; 2001 a. 16."
    (http://legis.wisconsin.gov/statutes/Stat0609.pdf)

    632.895 (13)
    "Breast reconstruction.
    632.895(13)(a)(a) Every disability insurance policy, and every self-insured health plan that provides coverage of the surgical procedure known as a mastectomy shall provide coverage of breast reconstruction of the affected tissue incident to a mastectomy.
    (http://docs.legis.wisconsin.gov/statutes/statutes/632/VI/895/8/f/2#/statutes/statutes/632/VI/895/8/f/2)

    Also found this:
    609.01(3)
    "(3) "Limited service health organization" means a health care plan offered by an organization established under ch. 185, 611, 613 or 614 or issued a certificate of authority under ch. 618 that makes available to its enrollees, in consideration for predetermined periodic fixed payments, a limited range of health care services performed by providers participating in the plan."
    (http://docs.legis.wisconsin.gov/statutes/statutes/609/01/3)


    I suggest you to email the Attorney General of Wisconsin. (http://www.doj.state.wi.us/ag/)


    Or better yet give the Wisconsin Insurance Commissioner a call:
    OCI (Office of the Commissioner of Insurance)
    1-800-236-8517, (608) 266-0103
    •All questions and/or complaints regarding insurance companies and policies
    (http://www.doj.state.wi.us/ag/contact.asp)

    Hope this helps.

    Hey, I just found this!
    As far as I can tell it may very well be covered!

    Drum roll, please...
    And I present the following directly from United HealthCare online:

    "2. In accordance with Federal and State mandates the following are covered:
     All stages of reconstruction of the breast on which the mastectomy was performed.
     Surgery and reconstruction of the other breast to produce a symmetrical appearance,
    including nipple tattooing
     Prosthesis (Implanted or external)
     Treatment of physical complications of mastectomy, including lymphedema"

    Please see:
    https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools and Resources/Policies and Protocols/Medical Policies/Medical Policies/BreastReconstruction_CD.pdf

    Wonder what they have to say about that now?!! =)