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Topic: Insurance coverage for tattoos?

Forum: Breast Reconstruction — Is it right for you? Discuss timing and various procedures and techniques.

Posted on: Dec 14, 2019 05:40PM

Col321 wrote:

  1. Did anyone receive any insurance coverage for nipple tattoos? I would love to get them to feel 'finished', but i think it will be $2K out of pocket if my insurance covers nothing. That is a bit much for me. I have a bcbs ppo plan, if anyone has similar coverage.
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Dec 14, 2019 06:04PM AnnC2019 wrote:

I heard this place does this free. They are located in Massachusetts.

https://www.spiltmilktattoo.com/

Dx 6/19/2019, ILC, Right, 3cm, Stage IIB, Grade 2, 1/1 nodes, ER+/PR+, HER2- (FISH) Hormonal Therapy 8/14/2019 Arimidex (anastrozole) Surgery 8/27/2019 Lymph node removal: Sentinel; Mastectomy: Right; Reconstruction (right): Tissue expander placement Radiation Therapy 11/4/2019 Whole-breast: Breast, Lymph nodes, Chest wall
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Dec 17, 2019 07:59PM Col321 wrote:

thanks for the info!

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Dec 22, 2019 03:12AM LisaK12 wrote:

For those of us who have already gotten the 3-D tattoos (love them!) from Vinnie or another non-medical tattoo artist, it would be helpful to know if anyone has succeeded in getting reimbursement (even partial) from their insurance company for the cost, and if so, what that process was like and how it worked. Thanks.

Dx 12/29/2017, DCIS, Left, Stage 0, Grade 1, ER+/PR+ Surgery 1/9/2018 Lumpectomy: Left Surgery 1/19/2018 Lumpectomy: Left Surgery 4/10/2018 Lymph node removal: Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Dec 22, 2019 11:08PM Gryffinmom wrote:

I fought with my insurance company about this but after two appeals they finally reimbursed me. My insurance is BC/BS. Federal law requires that if an insurer covers a mastectomy, it also must cover reconstruction. I had a letter from my plastic surgeon that said the tattoos were part of the reconstruction process. I had a receipt from Vinnie for the tattooing. I felt like BC/BS really gave me the run around, but part of the problem is that everyone I talked to there seemed puzzled by the tattooing (which seems oddsince I think it is becoming pretty common). I was given different reasons for the denials and the denial of my initial appeal was particularly ridiculous— it was some nitpicking complaint about the codes (despite the fact that the receipt clearly said it was for two nipple and areola tattoos, the BC/BS said I needed a more specific code because “without that we won’t know where on your body the tattoos are.” ) Anyway, I persevered and they eventually sent me a letter apologizing for the delay in reimbursement and a check.

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Dec 23, 2019 02:32PM AnnC2019 wrote:

GriffinMom,

If you have the codes that worked would you mind posting? I plan to have this done in the future

Dx 6/19/2019, ILC, Right, 3cm, Stage IIB, Grade 2, 1/1 nodes, ER+/PR+, HER2- (FISH) Hormonal Therapy 8/14/2019 Arimidex (anastrozole) Surgery 8/27/2019 Lymph node removal: Sentinel; Mastectomy: Right; Reconstruction (right): Tissue expander placement Radiation Therapy 11/4/2019 Whole-breast: Breast, Lymph nodes, Chest wall
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Dec 23, 2019 11:34PM Gryffinmom wrote:

Sure! I’m out of town until the New Year but I’ll send them once I get back Jan.1. I can also post the relevant portions of my appeal letter, including the citation to federal law regarding reconstruction vocersge

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Dec 24, 2019 08:56PM OnTarget wrote:

Great!!


Diagnosed at 42, Oncotype score 16, ITC in one node- considered node negative Dx 4/8/2019, ILC, Left, 3cm, Stage IB, Grade 2, 0/3 nodes, ER+/PR+, HER2- Dx 4/23/2019, ILC, Right, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2- Surgery 5/15/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 6/13/2019 Zoladex (goserelin) Chemotherapy 8/5/2019 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery 11/6/2019 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Dec 27, 2019 01:36AM LisaK12 wrote:

Oh Gryffinmom, that would be super helpful! I have BC/BS too.

Dx 12/29/2017, DCIS, Left, Stage 0, Grade 1, ER+/PR+ Surgery 1/9/2018 Lumpectomy: Left Surgery 1/19/2018 Lumpectomy: Left Surgery 4/10/2018 Lymph node removal: Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Jan 1, 2020 11:31AM Gryffinmom wrote:

I am home and looked up my appeal and the CPT code that Blue Cross required for the tattooing was 11922.

Getting BC/BS to reimburse me was not easy but worth it. Maybe these tips will be helpful:

1) Get a letter of medical necessity from your plastic surgeon. Here was what mine said: "Our patient, XXX, DOB XX/XX/XXX, has a diagnosis of previous right breast cancer. She has been under my care since XX/XX/XXX for bilateral breast implant reconstruction. She will require bilateral nipple & areola tattooing as part of her reconstruction process. In my opinion, this procedure is medically necessary for the following reason(s): (1) C50.912 malignant neoplasm of left female breast; (2) Z85.3 personal history of malignant neoplasm of female breast; and (3)Z90.13 acquired absence of bilateral breasts and nipples."

2) Most everyone I called at BC/BS tried to be helpful but not one of them was familiar with this process. One thing they were hung up on was the need for preauthorization (which you get from a "medical professional" and tattoo artists aren't "medical professionals.") My argument was that the language of the Women's Health and Cancer Rights Act of 1998 is unambiguous and clear: if a plan participant of beneficiary " is receiving benefits in connection with a mastectomy . . .and elects breast reconstruction in connection with such mastectomy" the health insurer is required to cover "all stages of reconstruction of the breast on which the mastectomy has been performed." [29 USC 1185b (a)] While the insurer might say that the tattooing has to be done by a "medical professional,' the federal law doesn't say that. And the intent of the law is that "all stages of reconstruction of the breast be covered."

3) I would suggest contacting your insurer before you get the tattooing and asking them how you should file this claim. Be sure to document every call (I asked BC/BS for a call reference number after each call. They had transcripts of every call, which was helpful to me since they showed that I had (1) followed the procedure they told me to follow and (2) been told different things by different representatives.)

4) If you get denied, don't give up. One representative told me that BC/BS would probably deny my claim but to keep appealing because they would probably come around. (I appreciated her honesty and she-- like all the reps I talked to was sympathetic and very pleasant-- but that made my blood boil a bit since it seemed like BC/BS was throwing up obstacles that I imagine discourage a lot of people to continue on in the process.)

Maybe my experience was unusual and most people don't have any trouble getting their tattooing reimbursement. But if you do have trouble, I hope the above is helpful.

(Final note, I have seen on different sites that whether or not you get reimbursed for tattooing depends on the insurance company. It's federal law and ALL insurers have to comply. I don't know if there are any court cases where someone has sued over an insurance company's overly restrictive interpretation of the law to exclude tattoo artists, but I imagine that if there isn't, there will be one day.)

Oh, I LOVE my tattoos. I was so glad that I got them.

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Jan 1, 2020 11:36AM Gryffinmom wrote:

Oh, I should add, that Trent Wyczawski with Vinnie Myers' team did my tattoos and he was so wonderful. He and Paul Bessette (also wonderful-- he talked to me during the whole procedure which was helpful because it was a little painful) travel around a lot and if you call they will give you the dates and places that they will be. The cost for both was $1200 and, per the terms of my insurance policy, I was reimbursed $600 by BC/BS.

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Jan 1, 2020 03:46PM AnnC2019 wrote:

Gryffinmom,

That is so helpful. Happy to hear that the tattoos look nice.

Happy New Year to youand your family.

Dx 6/19/2019, ILC, Right, 3cm, Stage IIB, Grade 2, 1/1 nodes, ER+/PR+, HER2- (FISH) Hormonal Therapy 8/14/2019 Arimidex (anastrozole) Surgery 8/27/2019 Lymph node removal: Sentinel; Mastectomy: Right; Reconstruction (right): Tissue expander placement Radiation Therapy 11/4/2019 Whole-breast: Breast, Lymph nodes, Chest wall
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Jan 1, 2020 07:08PM OnTarget wrote:

Thank you!!

Diagnosed at 42, Oncotype score 16, ITC in one node- considered node negative Dx 4/8/2019, ILC, Left, 3cm, Stage IB, Grade 2, 0/3 nodes, ER+/PR+, HER2- Dx 4/23/2019, ILC, Right, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2- Surgery 5/15/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 6/13/2019 Zoladex (goserelin) Chemotherapy 8/5/2019 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery 11/6/2019 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Jan 2, 2020 07:52AM LisaK12 wrote:

Thank you for the detailed info -- will try again with BCBS.

Dx 12/29/2017, DCIS, Left, Stage 0, Grade 1, ER+/PR+ Surgery 1/9/2018 Lumpectomy: Left Surgery 1/19/2018 Lumpectomy: Left Surgery 4/10/2018 Lymph node removal: Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Jan 4, 2020 12:23AM LisaK12 wrote:

Gryffinmom -- Did BCBS cover the whole amount or only a portion of it?

Dx 12/29/2017, DCIS, Left, Stage 0, Grade 1, ER+/PR+ Surgery 1/9/2018 Lumpectomy: Left Surgery 1/19/2018 Lumpectomy: Left Surgery 4/10/2018 Lymph node removal: Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Jan 4, 2020 09:41AM Gryffinmom wrote:

I only was reimbursed for half— I think because I hadn’t yet met my deductible (I had my mastectomy in October and my reconstruction in March). I was reimbursed the same way I would have for any other procedure, per the terms of my insurance policy

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Jan 7, 2020 07:53PM - edited Jan 7, 2020 07:54PM by July11986

Hey girls- Does anyone know if Medicare and my supplement will pay for tattoos? I appreciate every single one of you that share their experience, strength and hope.

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Feb 8, 2020 12:36AM LisaK12 wrote:

Thanks so much to Gryffinmom for your help. Just an update in case my experience helps anyone else. BCBS originally paid only $224.60 of the $800 cost for my Vinnie tattoos. I sent them a letter requesting reconsideration and today received a check for $506.97 -- so they ended up paying for $731.57 total of the $800 charge. The reason they cited was that this was a "one-time exception treating the provider's charge as the allowable charge due to the limited providers available to perform the service." I am very happy with this resolution, just annoyed that they denied so much of the initial claim. If anyone else is in a similar situation, it is worth the time and effort to ask them to reconsider.

Dx 12/29/2017, DCIS, Left, Stage 0, Grade 1, ER+/PR+ Surgery 1/9/2018 Lumpectomy: Left Surgery 1/19/2018 Lumpectomy: Left Surgery 4/10/2018 Lymph node removal: Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant
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Feb 9, 2020 11:05AM - edited Feb 9, 2020 11:46AM by besa

My understanding is that some skilled tattoo artists do tattoos in their own shop and as well are also associated with a plastic surgeons office and also do work there.

You might want to check to see if exactly where you have the tattoo done effects your insurance reimbursement.

It was a while ago for me (and things may have changed) but at that time my insurance would only cover the tattoo done in conjunction with a plastic surgeon. (I personally did not want a nurse with little artistic talent doing the tattoo.)Vinnie did work for me in conjunction with the nola plastic surgeons at their office in nola and it was covered. I did not think my insurance would have covered it at the time if I went to his shop in Maryland.



Dx 2007, IDC, 2cm, Stage IIA, Grade 1, 0/1 nodes, ER+/PR+, HER2-

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