What We Can Provide For Your Out Of Network Insurance Coverage If You Choose To Allow Us To Bill For Reimbursement From Your Insurance?
- Preoperative Authorization: After you schedule your surgery date, you will have to request for “out of network coverage” from your insurance carrier to allow Dr. Garramone to be your surgeon of choice. We will inform your insurance carrier that you have had a consultation with Dr. Garramone and he has determined you to be a good candidate for GenSculpt® FTM Top Surgery. We will request authorization from your insurance to provide surgical services to you as an “out of network” physician, so we can arrange for approval from your insurance carrier to have your surgery covered, and to arrange for our office to be reimbursed directly from your insurance carrier after your surgery.
- If your insurance carrier denies this request for authorization, then you will have to appeal this denial directly with your insurance. If they will not allow us to be an out of network provider, then you will need to “self-pay” for your surgery.
How Does Allowing Us To Bill Your Insurance Benefit You?
If your insurance allows for coverage of transgender surgery and services, then below is a list of why this will benefit you:
- Our Office will bill as an out of network provider for reimbursement by your insurance company. (We will try to get your surgical fees reimbursed to you if your insurance allows, which is about $6,500 for FTM Top Surgery to $12,500 if ManSculpture is performed)
- The Hospital and Surgery Center where the procedure is performed usually will accept your insurance, and will not require you to pay for their services up front. They will bill your insurance to cover the services. (which is about $1,650 to $2,200)
- The Anesthesiologist will usually will accept your insurance and will not require you to pay for their services up front. They will bill your insurance to cover the services. (which is about $1,650 to $2,200)
- The Pathologist will not send you a bill after surgery for their services. They will bill your insurance to cover the services. (which is about $270 to $400)
- Your Prescriptions after surgery will be covered by your insurance. (which is about $100)
This can only occur if we, as the surgery provider, are given permission by you to bill your insurance for the procedure. We will do as much as we can to get your surgery covered, but ultimately if your insurance company refuses to pay for the procedure, you will be responsible for the unpaid services.
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.