Insurance Information

Will Insurance Cover My Procedure?

Dr. Cambre is not a participating provider for any insurance plan. However, your insurance may pay benefits for all or a portion of your procedure, if you are eligible for coverage for the condition being treated. As a non-contracted provider of services, Dr. Cambre is allowed to set his fees independently of the insurance carrier. We require full payment of our professional fees prior to the procedure. Some insurance companies pay part or all of the costs of surgery if the condition impairs normal function. Each insurance company is different, however, and it is recommended that individuals check with their own insurance company representatives to determine if the company and policy provides coverage for the procedure in question. Because many employers frequently change policies, it is sometimes difficult to accurately estimate your insurance co-payment. Although our office will make every effort to ascertain the amount of benefits your insurance company will pay for the planned services, and to derive from that an estimate of your personal financial responsibility, in many cases this information cannot be obtained from the insurance company until the payment and explanation of benefits (EOB) is received, after the service has already been rendered. Also, some procedures combine both cosmetic and reconstructive elements (for example, correction of complications of previous breast implant surgery, rhinoplasty with correction of deviated septum, and some types of eyelid surgeries), and insurance carriers will deny benefit coverage for these elements of the procedure that they determine to be cosmetic in nature. In other cases, in spite of efforts by the patient and our office to verify that the insurance carrier will pay benefits for a given procedure, payment may be denied entirely or delayed indefinitely by the carrier, and disputes and grievances must be filed by the patient in order to obtain payment.

For this reason, in most cases, Dr. Cambre will require pre-payment of his entire professional fee for your procedure in advance of treatment, including fees for both the reconstructive and cosmetic elements, if applicable. This amount includes your outstanding deductible and the expected co-payment amount for the insurance portion of your surgery, and represents your maximal personal financial liability for Dr. Cambre's professional fees (not including any additional co-payments you may owe to the facility or anesthesia provider). You are responsible for pre-payment in full of any fee amounts which we anticipate will be denied as cosmetic by your insurance carrier, and we will not bill insurance for these services. As a courtesy, we ask that you keep us informed of any change to your insurance coverage or policy limits. It is important that all employment and insurance information about you is current, and that we have your correct personal contact information.

While insurance benefits generally are available for most reconstructive surgical procedures, cosmetic surgery is never covered by insurance, and the patient is responsible for payment of this portion of the fee, or any balance denied as "cosmetic" by the insurance carrier, in all cases.

It is the policy of our office to collect the full fee, co-payment, deductible, or pre-payment deposit from the patient or responsible party, for all office visits and surgical procedures at the time a covered service is rendered.

Fees for all Plastic Surgery procedures must be paid in full two weeks prior to the surgery date, in order to confirm and hold your scheduled surgery date.

Private Insurance: Your office visit or consultation will be billed at our customary fee, which is due and payable in full at the time of the visit. At the time of your procedure, you are responsible for any unpaid deductible or (anticipated) co-payment amounts according to the terms of your policy. Our office will assist you in determining these amounts, to the best of our ability. The patient is solely responsible for payment in advance, of any cosmetic surgical fee portion or for payment of any portion of the global fee denied as cosmetic in nature by the insurance carrier. In some cases, at our discretion (where pre-payment of the full fee would create a financial hardship for the patient), we will ask you to pay the outstanding deductible and any cosmetic (non-covered) services, and a partial payment (deposit) toward the full fee balance. After service is rendered, we will submit the bill for all eligible professional services rendered by Dr. Cambre to your carrier. Upon receipt of payment from your carrier, we will reimburse you, if applicable, for any payments we have previously received from you and the carrier which are over and above our global fee, up to the amount of your prepaid deposit for the service(s) rendered, less any allowed amounts, co-payments, non-covered services, or deductible amounts you may owe.

Medicare Patients: Medicare pays us directly for your care. You are responsible for any deductible and co-insurance. If (rarely) Medicare denies your procedure as cosmetic, you are responsible for the charges. When we anticipate that a procedure will be denied as cosmetic in nature, you will be responsible for payment in advance, and Medicare will never be billed for such procedures.

HMO Patients: Dr. Cambre does not participate in any HMO plans. We will be happy to see you on a cash-pay basis, but your medical insurance company will not pay for your treatment.

For more information regarding our insurance and fee policies, please call (310) 777-6677 and ask our staff. They are well informed and up-to-date on insurance matters.