A Word of Warning
I completed my final stage of breast reconstruction- tattooing of the areola/nipple complex. Many plastic surgeons in my county (Spokane) refer to this one female esthetician -- who is an out-of-network provider with regard to 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 for referrals 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 - including photos of her work.) She refused to provide a proper itemized bill -- she does not invest anything into overhead such as a computer, printer or even a stamp to mail me a bill. 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 complaint -- because this woman is regarded as out-of-network, the insurance has no authority to follow up on the complaint. Last, my insurance wants me to re-submit the claim because the woman provided an out-of-date Tax ID number on the Form 1500.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 -- the insurance reimburses at $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!). Interestingly this is exactly the amount she insisted on in cash and would not accept a credit card. However, she billed my insurance twice that amount ($1,200 - suggesting she could help me out by submitting a higher bill rate to insurance.)
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 (such as pink ribbons) 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, financing, insurance coverage, liability protection, regulation, oversight, etc.) be sure you see a licensed RN with esthetician training and one that is associated with your PS office or at least a dermatologist's office. Another alternative is to go to a tattoo parlor -- where the training, cost and artistry are likely to be superior. Tattoo parlors charge about $100 per hour and it takes less than an hour 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.
Even if the final outcome is perfect, this woman's charge is inappropriate. To put this in perspective, her charge is 50% higher than the allowable rate the nurse anesthetic (CRNA) received during a second-stage revision surgery. The total cost for complete tattooing (assuming 2 sessions) is more than an endoscopy, vasectomy and many other highly technical and skilled medical procedures.
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