Submitting For Reimbursement

In this setting- Abbie is working under her tattoo license (not her PA license).  For this reason, she can not contract with insurance companies.  We recommend that you contact your insurance provider ahead of time to learn about your plan’s out-of-network and reimbursement policies.  This way, you’ll know everything you need to submit the claim.  When you speak to the representative be sure to do the following:

  1. Have your policy number ready along with paper and pen to take notes.  Be sure the representative knows you are seeing a non-participating provider. Questions to answer during the call:
    1. Is prior authorization is needed for the procedure?  If so, your PCP submits for the prior authorization (just let Abbie know and she will email you all of the information your PCP will need to fill out the form).
    2. What are your out-of-network benefits?
    3. How do you submit for reimbursement after the tattoo?
  2. Inform the customer service representative that you have an “acquired absence of the breast(s) and nipple(s) due to your breast cancer (or genetic predisposition to breast cancer) diagnosis”
  3. Z85.3 is the diagnosis code for personal history of breast cancer.
  4. Z15.01 is the diagnosis code for genetic predisposition to breast cancer. 
  5. Inform the customer service representative that you have undergone mastectomy (ies) and breast reconstruction to rebuild the breast mound and you are seeking 3-D nipple and areola complex tattooing to restore that anatomy. 
  6. The procedure codes for the tattoo (s) are:
    11921 is the One side procedure code.
    11921 + 11922 is the Two sides procedure code.
  7. the PArlor/ Abbie are out-of-network.  What does your plan offer for out-of-network benefits?  Do you need an out-of-network referral?  (Out-of-network referrals come from your PCP). If you have no out-of-network benefits, ask if you can file a Network Adequacy Provision. 
    1. Network Adequacy Provisions-sometime called Network Gap Exceptions are tools that health insurance companies can use to compensate for gaps in their network.  Since there are no hospitals providing 3-D tattoos there is a gap in the in-network coverage and your insurance company may make an exception.
  8. NPI # for Abbie: 1144491101 Taxonomy 246ZA2600X- please be sure they know that Abbie is NOT A CONTRACTED PROVIDER IN THIS SETTING
  9. Each insurance company will have its own protocol for submitting for reimbursement, so take notes on anything they will need (receipts, letters of support, etc.).
  10. At the completion of your tattoo with Abbie, you will receive an itemized invoice, a procedure note and a letter of medical necessity.  This should also help with your reimbursement.
  11. If your insurance provider does not offer reimbursement, please explore Ink-4-Pink ,  Brigham and Women’s CHAT Program and The Ellie Fund for financial assistance.