Fees & Financing

If a significant spreading of the anterior muscles or a hernia is present, your insurance company may, rarely, reimburse you for a portion of the Surgery Center bill and of the professional fees. But the focus is on the word rarely! Insurance companies do not pay for the skin tightening during body contouring or other purely cosmetic portions, regardless of how much weight you have lost, how unsightly the remaining skin folds are, or even if the skin folds interfere with normal function. If there is reason to believe that your insurance company might help you pay for abdominal muscle tightening, the office staff will provide you with the necessary information to submit to your insurance carrier.

All fees are due prior to the surgical procedure and, if any portion of your procedure will be covered by your carrier, you will be reimbursed directly by your insurance company. 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 his/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.

I, _________________________________________________certify that I have read and understand the “Body Contouring – Post Massive Weight Loss Reconstruction” information sheets dated March 2008, that my surgeon has answered all of my questions to my satisfaction, that I understand and accept the risks associated with surgery, and that I give my informed consent for this (these) procedure(s).

Witness_______________________________ Date__________________

Initial if copy requested/given to patient____________________________ Copy placed in chart __________________________________________

Copyright 11/87 Last revised 03/08
Juris Bunkis, M.D., F.A.C.S.