Insurance does not cover cosmetic breast surgery. It may cover some of the cost of Functional Breast Surgery. The insurance issue is always a major source of frustration for both patients and surgeons. The decision of whether a surgery is cosmetic/aesthetic or functional is made by the insurance company and not the patient, patient’s employer, or surgeon. At your consultation, we can discuss the likelihood of obtaining insurance coverage, but ultimately that will be decided by your insurance company. Often, a process known as pre-authorization, where medical records, photographs, and a request letter, are sent to your insurance company in advance of the surgery, can assist you in determining your out of pocket expenses. Dr. Barnett is not a “participating physician” with any insurance companies, and while our office will work with you while you try to obtain pre-authorization, the patient remains responsible for communicating with their insurance company and for all costs related to my surgical fees and non insurance covered hospital and anesthesiologist fees. Our office will provide you with a quote for your surgery based on self-pay (not insurance pay) pricing. Dr. Barnett’s fees are fixed, and the hospital, surgery center, and anesthesiologists have fixed hourly rates for self-pay patients. Dr. Barnett’s fees do not vary if you can or cannot obtain insurance coverage. With insurance, hospital, surgery center, and anesthesiology fees do vary based on negotiated agreements and the negotiated fees may be higher or lower than the self-pay fees. We can discuss this with you further at your appointment.
What’s Right for Me?
In most cases, patients typically come into my office with an understanding of the goals they’d like to achieve whether they’re functional or aesthetic. We will spend quite a bit of time educating you about the process, anticipated results, recovery time risks and potential complications. This holds whether your issues are Aesthetic or Cosmetic. Your satisfaction is our goal.