Insurance | FTM Top Surgery ® | Dr. Charles Garramone The Best Surgeon

Insurance

Insurance & GenSculpt® FTM Top Surgery® Procedure
FMLA Paperwork
We have received many requests from patients for documentation to apply for reimbursement from their insurance carrier for some or all of their GenSculpt® FTM Top Surgery® Procedure costs. While our practice does not accept insurance for the GenSculpt® FTM Top Surgery® Procedure, nor are we contracted with any insurance carrier as a provider, we will help provide you with required documentation from our office to help you seek reimbursement from your insurance carrier (Does not apply to Medicare or Medicaid).

What We Can Provide For Your Insurance Coverage:

  • Preoperative Letter: After you schedule your surgery date, we will provide you with a letter documenting that you have had a consultation with Dr. Garramone and he has determined you to be a good candidate for GenSculpt® FTM Top Surgery®. The letter will include CPT codes so that you can arrange for approval from your insurance carrier to have your surgery covered, and to arrange to be reimbursed directly from your insurance carrier after your surgery. Again, you will need to arrange to have your insurance carrier reimburse you directly after the surgery. Do not have them forward us payment for the surgery.
  • Postoperative Letter: We will provide you with a letter describing the GenSculpt® FTM Top Surgery® Procedure and also provide some acceptable CPT codes for insurance reimbursement. The letter can be provided after surgery only, and will contain the following excerpt which will describe your procedure and the current procedural terminology. Here is an excerpt: “This procedure is commonly known as “FTM Top Surgery” or “bilateral double incision method with free nipple grafts”. This is a common procedure of gender reassignment for patients who identify as female to male transgender. “
  • Billing Statement: We will provide you with a detailed billing statement of all fees you have paid our office.
  • Medical Records: We recommend you contact and obtain a full copy of your medical records directly from the hospital or surgery center after your procedure is performed.  You can use these to submit to your insurance carrier along with the Letter and Billing Statement we provide to you.

We will provide the patient with these documents and will not modify their content. We will not communicate with your insurance carrier directly. We will not negotiate with your insurance carrier. We will not accept payment nor request payment from your insurance carrier. If we receive payment from your insurance carrier we will return it to the insurance carrier. Do not ask us to become a mediator between you and your insurance carrier, as all of these responsibilities are the responsibility of the patient, not our practice, and we are not required to communicate with your insurance carrier under any circumstance.

Many of our patients have used these documents to apply for either partial or near full reimbursement of their procedure costs from their insurance carrier.

What We Can Provide For Your FMLA Coverage:

  • After you schedule your surgery, we will provide you with a letter to apply for FMLA coverage. You can use this letter before surgery to make sure your FMLA coverage will be active during your recovery period. If you need any FMLA forms to be filled out, we would like you to please fill out all of the information you can and then forward us a copy of your completed FMLA form. We will then attach our FMLA letter, sign your FMLA form, and send this back directly to you for submission to your FMLA provider. The letter looks like this:

FMLA, disability, or short term leave of absence letter
I am a surgeon duly licensed to practice in the State of Florida located in the United States of America. My medical license number is OS 9076. I am a physician whose office is located at:
    4725 SW 148th Ave, Suite 202, Davie, FL 33330

This letter is in regard to my patient, PATIENT NAME, whose date of birth is DATE OF BIRTH.  This letter is for the patient to apply for FMLA, disability, or short term leave of absence from work or school or jury duty.

Date condition commenced: SURGERY DATE
Probable duration of condition: 6 weeks from the date condition commenced. After 6 weeks, the patient may return to unrestricted full duty at their place of employment, which is on this date:_______________
Regimen of treatment to be prescribed:
    By Physician: basic wound care (instructions given to patient to follow)
    By another provider of health , if referred by Physician: none
Is inpatient hospitalization of the employee required?: No
Is employee able to perform work of any kind?: Yes, light duty only after two weeks
Is employee able to perform the functions of employee’s position? Yes as follows:
•    only light duty or sedentary position (telephone and computer work okay)
•    no heavy lifting over 5 pounds
•    no overhead reaching or repetitive use of arms
•    arms must remain down by patients side
•    no standing for long periods of time
•    no climbing, other than stairs
•    must be indoors and in a clean dry environment
Did our office prescribe any narcotic prescription medication?: Yes, only to be used during the first two weeks postoperatively as needed, but may show up on drug screening tests for several weeks.

This should qualify PATIENT NAME to be allowed leave of absence from work, school, jury duty, or gym membership.”

Our Commitment To You

Our practice is committed to offering you the best care and we are committed to keeping the cost of your medical care low. We hope this will help you with your transition and help you with the rising costs of medical care that all patients and physicians are facing. Remember, just because a surgeon may be a provider for your insurance carrier, this does not mean they are a qualified expert in performing FTM Top Surgery®. Please do not jeopardize your final surgical outcome based on your insurance company’s network of providers. Currently there are many surgeons who are offering FTM Top Surgery® services, but there are very few who have adequate experience and very few who are very good at achieving a great result with your first surgery. Please follow the recommendations from other patients who have had a good outcome with an experienced Plastic Surgeon such as Dr. Charles Garramone.