Sep 11, 2010 09:56PM
Sep 12, 2010 03:54PM
A Word of Warning
I recently completed my final stage of breast reconstruction- tattooing of the areola/nipple complex. Many plastic surgeons in my area (Spokane county) refer to this one female esthetician -- who is an out-of-network provider regarding my insurance.
This woman is questionable -- she charges a medical bill rate but her services and care do not match any standard. (She claims she must charge a rate that is based on insurance guidelines - she doesn't set the rate.) According to my insurance, not one breast reconstruction surgeon that the insurance contacted to get a referral knew this woman's last name -- although they recommended her. There is no evidence that she is licensed, bonded, trained, regulated or insured. (There is zilch in her rented space for documentation.) She refused to provide a proper itemized bill -- in fact, she seems to be pocketing her medical bill rate instead of investing in overhead as simple as a computer and printer. She filled out the Form 1500 (necessary for out-of-network billing) incompletely - leaving out her phone number and the necessary DRG codes. My insurance company has never heard of this woman and has no record of her in its database -- although she told me that she had been doing nipple tattooing for 20 plus years. In addition, she goes by at least 2 different last names - the one she submitted on the insurance form and the other that appears on my caller ID. She is nowhere to be found in the phone book.
THrough my insurance company, I filled out a quality of service complain -- but because this woman is regarded as out-of-network, the insurance has no authority to follow up on the complaint. Last, my insurance now wants me to re-submit the claim because the woman provided an out-of-date Tax ID number on the Form 1500. And because she is out-of-network, she can charge anything she wants -- but the insurance only reimburses at a low level ($600 the first round) and at 60% of that $600 and only after a high out-of-pocket deductible is met. (No wonder this woman can drive around in a high-end, foreign-made sports car!)
I am not sure what breast cancer patients in Spokane are suppose to do -- dare go against the recommendation of their plastic surgeon and risk an inferior outcome -- or use this questionable provider? Unfortunately, some women also trust this woman to get very "underwhelming" tattoos (a pink ribbon) in addition to getting a nipple/areola tattoo .
Be careful -- tattooing is regarded as a cosmetic procedure and is not regulated by the FDA. However, there are medical consequences such as allergic reaction and skin infection. To get everything you expect of a medical bill rate (medical care/procedure, office atmosphere, HIPAA compliance, trained staff, billing, insurance coverage, liability protection, regulation, oversight, etc.) be sure you are seeing a licensed RN with esthetician training associated with your PS office. Another alternative is to go to an tattoo parlor -- where the training, cost and artistry are likely to be superior. Tattoo parlors charge about $100 per hour and it takes only an hour for an experienced artists to do a tattoo of this nature.
I spent a lot of time, money and effort on reconstruction and I certainly did not want to jeopardize my final result with a questionable provider. My first-round result isn't great -- to get something acceptable I will need another round of tattooing and potentially a third.
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