AREOLA RESTORATION AFTER MASTECTOMY
Insurance & Reimbursement
What the law says, what your plan decides, and the paperwork we give you.
THE SHORT VERSION
The law is on your side, the plan has the details
The Women's Health and Cancer Rights Act of 1998 requires group health plans and individual policies that cover mastectomy to also cover reconstruction of the breast, including procedures to produce a symmetrical appearance. Nipple and areola tattooing is widely treated as part of that reconstruction, and insurers use procedure codes 11920, 11921 and 11922 for it.
Three honest limits. The Act applies to private insurance, not to Medicare or Medicaid, although some of those plans cover tattooing anyway. Every plan sets its own rules on who may perform it: some reimburse only a physician or an in-network provider, some reimburse an independent tattoo artist, and some decide case by case. And every plan has its own deductible, out-of-network rate and claim form, so the amount you get back varies. We cannot promise coverage or a number. We can promise that the paperwork you take away is complete and correct.
BEFORE YOU BOOK
Three questions for your plan
Call the member-services number on your card and ask:
1. Is nipple-areola tattooing, procedure code 11920, covered under my breast reconstruction benefit?
2. Does it have to be performed by a physician or an in-network provider, or will you reimburse an independent tattoo artist as an out-of-network claim?
3. Do I need pre-authorisation or a letter from my surgeon first?
Write down the date, who you spoke to, and what they said. If the answer to the second question is a physician only, ask your surgeon's office whether they can order the procedure or bill it on your behalf.
HOW A CLAIM WORKS
Four steps
STEP 1
Your surgeon's note
Most plans want a short letter or prescription from the reconstructive surgeon stating that the tattooing completes your reconstruction. Surgeons' offices write these routinely.
STEP 2
Your visit
You pay the studio at the time of service. You receive an itemised receipt showing the date, the procedure codes, and the studio's details.
STEP 3
File the claim
Send the receipt, the surgeon's note and your plan's member claim form to the claims address on your card. Keep copies of everything.
STEP 4
If it is denied
Ask for the denial in writing and the reason. Many denials are paperwork, not policy, and can be appealed with the surgeon's letter and a reference to the Women's Health and Cancer Rights Act. Your surgeon's office and your state insurance department can both help.
WHAT WE PROVIDE
An itemised receipt with the procedure codes for each visit.
A one-page description of the procedure for your file or your surgeon's office.
Photographs of the completed work, if you would like them for the claim.
WHAT WE DO NOT DO
We do not bill insurers, and we are not in any plan's network. We cannot guarantee coverage, a timeline, or an amount. Scar camouflage and cosmetic work are not covered by insurance.
QUESTIONS ABOUT COVERAGE
Ask before you book
Bring what your plan told you to the consultation and we will go through it together.