Insurance Coverage

Richmond Aesthetic Surgery accepts insurance reimbursement for procedures deemed “medically necessary” by insurance carriers. As a courtesy, we will file claims on behalf of patients with eligible insurance plans. Patients are responsible for all applicable administrative fees, deductibles, copayments, and coinsurance as determined by their individual plans. Additional fees for non-covered services may also apply. Ultimately, the patient is responsible for the cost of their procedure.

• Procedures Eligible for Coverage
• Accepted Insurance Providers
• Self-Pay Options
• Breast Reconstruction Insurance Coverage

Procedures Eligible for Coverage

The following procedures may be eligible for insurance coverage:

• Breast Reduction
• Breast Reconstruction (including reconstruction following cancer)*
• Female-to-Male (FTM) Top Surgery**
• Scar Revision
• Removal of Malignant or Suspicious Skin Lesions and Keloids

Accepted Insurance Providers

Richmond Aesthetic Surgery is in-network with the following insurance providers:

Anthem / Blue Cross Blue Shield

We accept a wide range of Anthem/BCBS plans, including traditional PPO and HMO options. Many BCBS plans may cover procedures when symptoms such as chronic pain or functional limitations are well-documented. Our team can review your benefits and outline any steps needed for approval.

Aetna

We accept a wide range of Anthem/BCBS plans, including traditional PPO and HMO options. Many BCBS plans may cover procedures when symptoms such as chronic pain or functional limitations are well-documented. Our team can review your benefits and outline any steps needed for approval.

Cigna

Cigna PPO plans are welcomed at our practice, and they may offer coverage for procedures when symptoms are clearly documented. Our staff assists with verifying benefits and preparing the supporting documentation needed for Cigna’s pre-authorization process.

Humana

Humana PPO members may qualify for coverage when medical necessity is established. We guide patients through Humana’s review requirements and help compile the clinical information needed to support their claim. Benefit verification is completed during your consultation.

Medicare

We accept Medicare Part B and many Medicare Advantage plans administered through Anthem/BCBS. Medicare may provide coverage for procedures when symptoms significantly interfere with daily activities and conservative treatments have not been effective. Our office can help confirm eligibility and expected out-of-pocket costs.

PHCS

Our practice participates in the PHCS network for a variety of medically necessary procedures. Coverage typically depends on meeting the insurer’s clinical criteria and providing the appropriate medical documentation. Our team will help verify your benefits and ensure all required records are submitted.

Sentara

We accept Sentara PPO and POS plans, which may cover procedures when a patient’s symptoms meet the insurer’s medical necessity criteria. Our team assists with gathering the appropriate clinical records and navigating Sentara’s authorization steps.

Tricare

Tricare Prime and Tricare Select are accepted for patients who qualify for medically necessary procedures. Coverage typically requires a clear record of persistent symptoms and functional limitations. Our staff helps coordinate referrals, documentation, and benefit verification.

United Healthcare

United Healthcare PPO plans and Multiplan coverage are welcomed at our practice for eligible medically necessary procedures. Coverage decisions often depend on meeting UHC’s clinical criteria and providing adequate supporting documentation. We guide patients through benefit verification and any required pre-authorization steps.

Our practice is committed to fair billing practices, and our experienced insurance staff will work with you to estimate costs before your procedure. We work with a wide range of additional insurance providers beyond the major carriers listed above. If you don’t see your plan included, our team can review your benefits and help you understand how your coverage applies to your visit or procedure.

Self-Pay Options

We also offer self-pay options for all procedures.

Breast Reconstruction Insurance Coverage

As a breast reconstruction patient you are beginning a life-changing journey that is both stressful and oftentimes uncertain. You may undergo cancer surgery, reconstruction, chemotherapy, and radiation. Treatment is a multi-staged process and may last 6 to 12 months. You will be treated by numerous medical professionals along the way and facilities that will bill your insurance company for your treatment. Dr. Zemmel and the Richmond Aesthetic Surgery Team recognize that navigating today’s healthcare system can be very difficult and frustrating. Our team at Richmond Aesthetic Surgery will assist you in any way possible to make this part of the journey as smooth as possible.

Prophylactic mastectomy (preventative mastectomy) is almost always covered as well. Patients undergoing prophylactic mastectomy usually have an extensive family history of breast cancer or are BRCA1/2 positive (genetically positive). Again once your insurance carrier agrees to cover the mastectomy federal law mandates coverage for the reconstruction.

American Cancer Society Website Summarizing the Law

Not only does the WHCRA law cover reconstruction of the absent breast but it also covers any symmetry matching procedures including mastopexy (breast lifting), breast augmentation, or breast reduction. It also covers reconstruction of the nipple and final areola tattooing.

Many patients elect for an implant based reconstruction. While today’s breast implants are very safe, no implant is a lifetime device. All patients should expect to replace them at some point in the future. Many patients ask if future implant maintenance/replacement is covered by insurance, and of course the answer is “yes.”

Once you become a breast cancer/reconstruction patient insurance must cover you treatment for your lifetime.

If you have any questions regarding your insurance plan or coverage of breast reconstruction, please do not hesitate to call our offices or discuss these issues with Dr. Zemmel during your initial consultation.