Insurance Coverage Issues

	The question of insurance coverage for gender related surgical procedures has arisen on occasion. Most insurance carriers provide no coverage for any surgery related to gender reassignment. This ranges from chest reconstruction surgery, be it mastectomy and nipple/areolar reconstruction, subcutaneous mastectomy, genital surgery, or secondary cosmetic surgery. We do not work directly with insurance companies. Dr. Brownstein does not negotiate his fees and therefore does not contract with any insurance companies or HMOs. Fees for surgery are to be paid in full three weeks prior to the surgery date, whether by the patient, or by the insurance company should the patient have been able to make some arrangement for this payment. It is a violation of medical ethics and illegal to attempt to obtain coverage using innacurrate diagnosis codes or procedure codes. This subjects the surgeon to the risk of being removed by the insurance company as an approved provider and loss of payment as well as being reported to the medical board. It also subjects the patient to possibly being dropped by the insurance company for any and all coverage. If you have insurance coverage and wish to be reimbursed for surgical services, please contact your insurance carrier to determine if coverage for these procedures is provided by the terms of your particular policy. Following surgery we will provide a statement of professional charges including appropriate codes for the patient to submit to the insurance carrier. If you have any questions regarding your potential insurance coverage for procedures you are considering, you may contact the company directly.