Richmond Aesthetic Surgery accepts insurance reimbursement for procedures deemed “medically necessary” by insurance carriers. As a courtesy, we will file claims on behalf of patients with eligible insurance plans. Patients are responsible for all applicable administrative fees, deductibles, copayments, and coinsurance as determined by their individual plans. Additional fees for non-covered services may also apply. Ultimately, the patient is responsible for the cost of their procedure.
The following procedures may be eligible for insurance coverage:
- Breast Reduction
- Breast Reconstruction (including reconstruction following cancer)*
- Female-to-Male (FTM) Top Surgery**
- Scar Revision
- Removal of Malignant or Suspicious Skin Lesions and Keloids
Insurance Network Information:
Richmond Aesthetic Surgery is in-network with the following insurance providers:
- Anthem/BCBS
- Tricare Prime
- Tricare Select
- BCBS HealthKeepers Plus (Medicare and Medicaid plans)
We accept patients with Aetna, Cigna, and UnitedHealthcare, but we are considered out-of-network with these carriers. Patients with these plans must have out-of-network benefits. Our practice is committed to fair billing practices, and our experienced insurance staff will work with you to estimate potential out-of-pocket costs before your procedure.
Self-Pay Options
We also offer self-pay options for all procedures.
Breast Reconstruction Insurance Coverage
As a breast reconstruction patient you are beginning a life-changing journey that is both stressful and oftentimes uncertain. You may undergo cancer surgery, reconstruction, chemotherapy, and radiation. Treatment is a multi-staged process and may last 6 to 12 months. You will be treated by numerous medical professionals along the way and facilities that will bill your insurance company for your treatment. Dr. Zemmel and the Richmond Aesthetic Surgery Team recognize that navigating today’s healthcare system can be very difficult and frustrating. Our team at Richmond Aesthetic Surgery will assist you in any way possible to make this part of the journey as smooth as possible.
Prophylactic mastectomy (preventative mastectomy) is almost always covered as well. Patients undergoing prophylactic mastectomy usually have an extensive family history of breast cancer or are BRCA1/2 positive (genetically positive). Again once your insurance carrier agrees to cover the mastectomy federal law mandates coverage for the reconstruction.
American Cancer Society Website Summarizing the Law
Not only does the WHCRA law cover reconstruction of the absent breast but it also covers any symmetry matching procedures including mastopexy (breast lifting), breast augmentation, or breast reduction. It also covers reconstruction of the nipple and final areola tattooing.
Many patients elect for an implant based reconstruction. While today’s breast implants are very safe, no implant is a lifetime device. All patients should expect to replace them at some point in the future. Many patients ask if future implant maintenance/replacement is covered by insurance, and of course the answer is “yes.”
Once you become a breast cancer/reconstruction patient insurance must cover you treatment for your lifetime.
If you have any questions regarding your insurance plan or coverage of breast reconstruction, please do not hesitate to call our offices or discuss these issues with Dr. Zemmel during your initial consultation.