Fees and Financing

All fees will be discussed freely in advance by the office staff. Your insurance company may cover at least part of the fee if an excess of 500 grams of breast tissue is to be removed. Insurance companies never pay the entire fee for breast reductions or for any other procedures that are designed solely to improve your appearance. As such, you cannot expect the insurance carrier to cover the cost of a mastopexy procedure. You will be responsible for any portion of the fee for a breast reduction not covered by the insurance carrier.

In compliance with suggestions adopted by the American Society of Plastic Surgeons, it is customary for the patient to pay all fees for cosmetic surgery prior to the desired operation. This insures that the patient is sincere in her motivation and can afford the surgery, thus creating a better patient/physician relationship. A non-refundable deposit will be required to secure your desired surgery date. The remainder of the fees must be paid prior to the surgery, no later than the time of the preoperative visit, one week before surgery. Additional fees are also required for laboratory tests, surgical facility fees, the anesthesiologist, and if necessary, mammography. If additional surgical procedures become necessary, additional facility, laboratory, anesthesia, implant costs and professional fees will be incurred. The surgical facility and anesthesiologist fees quoted will be based on our best faith estimate; the final fee may vary as these fees are based on surgical time, and it is not always possible to predict exactly how long a procedure will take to complete. It is important that you understand that the patient is responsible for all costs associated with all secondary surgical procedures or for the treatment of any complications that may arise as a result of this elective surgery.

Please note that if a functional component exists (very large breasts exceeding 500 grams of tissue), if requested, our office staff may be able to assist you with you insurance forms. However, payment of all fees is the patient's responsibility. Recovery of any insurance benefits is between you and your insurance company. The surgeon's fee does not include laboratory, pathologist, anesthesiologist or hospital/facility charges. It is important that you understand that the patient is responsible for all costs associated with secondary surgical procedures.

I, _____________________________________________certify that I have read and understand the" Reduction Mammoplasty/Mastopexy" information sheets dated May 2005, that my surgeon has answered all of my questions to my satisfaction, and that I give my informed consent for this procedure.

Witness_______________________________ Date__________________

Copyright, 11/87, Last revised 05/05
Juris Bunkis, M.D., F.A.C.S.