Have Insurance Questions? We’re Here to Help!
Doc, I found my surgeon, but they are out of network, what do I do?
Please reach out to our office to investigate your specific situation a little further. We work with some insurance companies that will do benefit exceptions to consider certain procedures in network if they do not have an in-network surgeon. Even if that is not the case, you may have out-of-network coverage you can take advantage of. Our insurance coordinator can verify if you have out of network coverage, confirm your plan benefits and outline the process with our office for you.
Doc, how much does top surgery cost with insurance and how do I figure that out?
If you are a patient who has insurance, your out-of-pocket cost depends on whether or not we are in network with your insurance company. If we are in network, or the insurance company issued a benefit exception to consider your surgery in-network, we would bill your insurance and you would just be responsible for any patient cost-shares (deductibles, co-pays or co-insurance) as outlined by your insurance policy. We can provide an estimate of your cost share after our insurance coordinator has gotten prior authorization from your insurance provider.
If we are out of network with your insurance, we would require you to pay our compassionate care rate, which usually ranges from $9,400 to $13,050. We would give you a personalized quote at your consultation appointment. Our insurance coordinator would get prior authorization before your surgery and provide you with the necessary paperwork after surgery so you can submit to your insurance on your own to get reimbursed. Please be aware that the insurance would base any reimbursements on their allowable fees and the percentages based on your policy, so your reimbursement will be less than the fee you paid.
Doc, do you take Kaiser insurance?
We are in network with Kaiser of Washington only. Please reach out to the Kaiser Gender Care Team to get the process started and please request Dr. Mangubat specifically. Once Kaiser has issued their authorization for a consultation, we would be happy to schedule your appointment.
Doc, I’m self-paying do I still need a letter from my mental health counselor?
We follow WPATH standards even if you do not use insurance. If you are 18 years or older, we would require one letter from either your mental health provider or your PCP supporting you having this surgery. If you are younger than 18, we would require 2 letters, one from your mental health provider and one from your PCP.
Are consultations free?
Yes, if you are using insurance and they have benefits for transgender care, we would bill the consultation to your insurance, and you would be responsible for any patient cost-shares as outlined by your policy. Once insurance has paid their portion we would bill you for any remaining patient cost-share (like deductibles or co-pays). If you have a Kaiser PPO plan, we would collect any patient cost-shares at the time of the appointment. If you end up scheduling your surgery and paying the entire surgery fee on your own (using no insurance or out-of-network coverage) we generally write-off the patient portion of the charge. If you are not using insurance at all, the consultation is part of the surgery fee and there is no additional cost at the time of the appointment. If at some point after this appointment you decide to use your insurance, we would bill the consultation charge to your insurance at that time.
Does insurance pay for consultations?
Yes, if you are using insurance for your surgery, we would bill the consultation to your insurance, and you would be responsible for any patient cost-shares as outlined by your policy.
Can I have more than one consultation?
We want to make sure you are well informed before moving forward with surgery. If you think of any further questions after your initial consultation, we would be happy to schedule another appointment for you. Please be aware that this visit would be billed to your insurance just like your first consultation.
What is compassionate care rate?
The compassionate care rate is a discounted rate for self-pay patients.
Does every Doctor have an insurance coordinator who will help me understand what my benefits are?
We are not sure if other surgeons have insurance coordinators available to their patients. Our mission is to educate and help patients as much as we can throughout the entire surgery process. We know that insurance can be daunting and scary. We want to make this process as easy as possible for our patients and ensure that patients have a specialized contact person at our office to assist with all of their insurance needs.
How can I best prepare and understand what my insurance will actually pay for?
Please reach out to our office and our insurance coordinator would be happy to help you understand your insurance coverage with our office and explain all the insurance details to you. She can also advise you on the best plan if you are looking to change your coverage or help you if you need to contact your insurance provider.
How do I find out what my final cost will be? Does insurance cover post op binders?
We would be happy to give you an estimate for what your out-of-pocket cost will be once we have seen you for a consultation and know your exact treatment plan. Whether you are using insurance or pay for your surgery on your own, the surgery fee includes all surgery related charges at our office. Surgeon’s fee, facility fee, anesthesia fee, pre-and post-operative visit and garments are all included, and your only other additional costs would be prescriptions and laboratory fees, which may be covered by insurance depending on your insurance plan.
Does insurance cover revisions?
In most cases yes, however there are some insurance plans that do not cover revision and our insurance coordinator can assist with finding out if your policy would cover a revision surgery with our office.
Will insurance cover my post op medications?
If you have prescription coverage with your insurance plan, your medication should be covered under that plan. Please provide your insurance card to the pharmacist when you take in your prescription.
Does insurance cover scar treatment?
We have not found any insurance plan that covers scar treatments. If you had surgery with our office, Dr. Mangubat generally does not charge for post-operative scar care like steroid injections for Keloid scarring or if scar cream if needed. For more involved scar revision surgery there may be a charge, but those are rarely needed.
What’s a list of 10 top questions I can ask my insurance company and try to sort out what my benefits and how it will apply to top surgery? FFS (Facial Feminization Surgery) ? HRT?
Please reach out to our office and our insurance coordinator will help answer all the questions you may have. In most cases you do not have to call your insurance on your own, we can do that for you. However, there are a few insurance companies that are not too forthcoming with information if we are out-of-network, and our insurance coordinator may instruct you to call your insurance provider directly and she will give you guidance and let you know what to ask.
Dealing with insurance…where do I even start?
We would be happy to help you get started. Please email us a picture of the front and back of your insurance card and your date of birth, and our insurance coordinator will get back with you within a couple of days to outline the coverage you have with our office and explain the process.
Hey Doc, what do I do when I have multiple insurance plans?
If you have multiple insurance plans and are planning to undergo gender affirming surgery, there are a few things you need to keep in mind to ensure that you maximize your insurance benefits.
Your insurance companies generally will work together to pay for your medical expenses. Coverage can vary greatly, depending on your policy and whether we are in network or out of network with your insurance. Please call our office and our insurance coordinator can help you determine which insurance plan should be billed first, based on the rules of coordination of benefits. She will also explain the process with our office based on your insurance plans.
It’s important to note that even with coordination of benefits, you may still have out-of-pocket expenses. This could be in the form of copayments, deductibles, or coinsurance.
If you have any questions or concerns about your insurance coverage for gender affirming surgery, don’t hesitate to reach out to our office and we will connect you with our insurance coordinator. She can help you navigate the complexities of insurance coverage, and work with your insurance companies to ensure that you receive the maximum benefits available to you.
What do I do if my insurance changes or I add a second insurance plan after I have started the insurance process for approval or have received approval already.
It is important to contact our office immediately and provide a copy of the front and back of your new insurance card. Our insurance coordinator will check into your new coverage to determine the preauthorization requirements and submit a request for approval from your new insurance. If you are now covered under a second plan, it is also important to submit a copy of the card as well, our insurance coordinator can help to determine which plan is primary and if a preauthorization will be needed.
* Insurance coverage in general is only for transgender care. All of our other services are not medically necessary and would not be covered by insurance.
For Self-Pay Patients
The fees indicated on the quote you have been or will be given are for the procedures listed and reflect a compassionate care rate for self-pay patients. Please review the quote to ensure all desired services are included. Any additional discounts given are for the procedural plan as listed. Deviation from that plan may result in loss of discount. Dr. Mangubat’s quotes are an estimate only and are subject to change at the doctor’s discretion. His quotes for self-pay patients are inclusive of the following expenses: all operating room (facility) fees, doctor’s fees, anesthesia, implants (when applicable), pre-op and post-op visits.
Fees do not include prescription drugs, necessary laboratory fees or additional garments. Any revisions or touch ups are subject to additional facility, doctor and anesthesia fees. In the event that Lab Work/EKG/Medical Clearance is required prior to surgery, we must receive documentation prior to your pre-operative appointment or we reserve the right to cancel surgery (please refer to our cancellation policy).
Booking Surgery: A deposit of $1,000.00 is due at the time you schedule your surgery to reserve the surgery day. Surgery times are scheduled to benefit all patients as determined by the doctor. As such, your time may change so we ask that all patients be flexible with the actual time of their surgery. A deposit holds a date for surgery, not the time. The remainder of the procedure fee is due two (2) weeks (14 days) prior to surgery or at the pre-operative appointment, whichever comes first.
Surgery Days: Dr. Mangubat’s surgery days are Wednesday and Thursday 8:00 am to 2:00 pm, and Friday 8:00 am to 1:00pm. Surgeries are performed at our Tukwila surgery center at 16400 Southcenter Parkway, Suite 101. Available days should be discussed with our front office staff.
Types of Payment: Payments may be made to our office by cash, check, cashier’s check, money order, Visa, MasterCard or through an approved finance company. Dr. Mangubat also accepts Discover and American Express. Third party and business checks are not accepted. Personal checks cannot be accepted less than two (2) weeks (14 days) prior to surgery.
Cancellation Policy: The deposit is fully refundable up to fifteen (15) days prior to surgery. Surgery cancellations within 1-2 weeks (8-14 days) of surgery are eligible for a 50% refund. Surgery cancellations within 7 days of surgery are not eligible for a refund.
For Insurance Patients
Our Ambulatory Surgical Facility here at La Belle Vie Cosmetic Surgery Center and E Antonio Mangubat, M.D. are not in-network with any insurance companies. On a case by case basis a few insurance companies will grant a benefit exception and pay our facility and related charges at the in-network benefit level, this is negotiated prior to any services being rendered and you will be advised of this approval.
Some of the procedures we provide may be covered by insurance. Our insurance coordinator or front office staff can confirm if the procedure you are considering can be billed to your insurance. If your surgery can be billed, please be sure you have completed the necessary insurance paperwork and provided us with a copy of your insurance card. Our insurance coordinator will verify benefits, obtain pre-authorization and submit all covered charges to your insurance company.
You will be responsible for all deductibles, co-payments, co-insurance amounts or any other patient responsibility indicated by your insurance carrier or our financial policies, which are not otherwise covered by an accepted supplemental insurance.
Booking Surgery: Surgery can be scheduled once we have received either a signed letter of agreement from your insurance carrier, a prior authorization approval, or it has been verified that prior authorization is not required by you insurance carrier. Surgery times are scheduled to benefit all patients as determined by our surgeons. Thus, your time may change so we ask that all patients be flexible with the actual time of their surgery. Any patient cost shares for pre-operative visits and surgery, such as deductibles, co-pays and co-insurances are due at the pre-operative appointment, which is usually scheduled for 10-14 days, but can be as much as 30 days before the scheduled surgery appointment.
Surgery Days: Dr. Mangubat’s surgery days are Wednesday and Thursday 8:00 am to 2:00 pm, and Friday 8:00 am to 1:00pm. Surgeries are performed at our Tukwila surgery center at 16400 Southcenter Parkway, Suite 101. Available days should be discussed with someone at the front desk.
Types of Payment: Payments for any patient cost-shares may be made to our office by cash, check, cashier’s check, money order, Visa, MasterCard or through an approved finance company. Dr. Mangubat also accepts Discover and American Express. Third party and business checks are not accepted. Personal checks will not be accepted less than two (2) weeks (14 days) prior to surgery.
Cancellation Policy: We do require 2 weeks (14 days) notice if you need to cancel your surgery. If surgery is cancelled with less than 2 weeks’ notice, you may forfeit part or all of the fees or deposit already paid.
Lapse of Coverage or Non-Payment by Insurance: You are responsible for ensuring there is no lapse in coverage for services provided. If there are any lapses in insurance or your policy does not cover certain services, you are responsible for all charges. Most insurances cover at least part of a charge but if you have any questions on coverage we encourage you to talk to our insurance coordinator or call your insurance provider.
Change in Insurance Information: You are responsible for informing us of any changes in your insurance status. If you received a new insurance card or have any changes in insurance provider, policy, or coverage, please let our office know as soon as possible. It is important to keep this information up to date so that your medical claims are paid correctly and promptly. If your insurance changes after prior authorization has been obtained, a new prior authorization may be required.
Collections: Should collection proceedings or other legal action become necessary to collect an overdue or delinquent account, you understand that La Belle Vie has the right to disclose to an outside collection agency or attorney all relevant personal and account information necessary to collect payment for services rendered. You are responsible for all costs of collection including, but not limited to: late fees, interest due as a result of delinquency, all court costs and fees to the extent allowed by law. If your account is referred to a collection agency, attorney, court, or the past due status is reported to a credit reporting agency, it may have an adverse effect on your credit history; and related portions of your account, including the fact that you received treatment at our offices, may become a matter of public record.