Step-by-Step Guide to Getting Coverage

This guide walks you through how most clients at Kinesis Studio handle insurance reimbursement for areola tattooing. You typically pay upfront, then request repayment from your insurance because specialized artists like us are usually treated as out-of-network.

Quick Checklist

• Ask your surgeon/oncologist for a Letter of Medical Necessity (LMN)

• Call your insurance before your appointment

• Book your session and pay upfront at Kinesis Studio

• Submit your claim package for reimbursement

• If denied, file an appeal

Step 1: Get a Letter of Medical Necessity

Ask your breast surgeon or oncologist for a Letter of Medical Necessity (LMN) for nipple–areola tattooing.

The letter should:

• Confirm your history of mastectomy and reconstruction

• State that you are cleared for areola tattooing (often at least 12 months post-surgery or when fully healed)

• Clearly say this is reconstructive, not cosmetic

• Note emotional/psychological benefits (body image, confidence, quality of life)

Helpful (but optional) details your doctor may include:

• ICD-10 codes for your diagnosis and post-mastectomy status

• CPT codes related to reconstructive work (e.g., codes in ranges your surgeon commonly uses)

Keep a copy for yourself; you’ll submit it with your claim.

Step 2: Call Your Insurance Before Your Appointment

Turn over your insurance card and call Member Services.

You can say:

“Hi, I’m a breast cancer survivor (or previvor). I’ve had a mastectomy with breast reconstruction and I’m completing the final stage, nipple–areola tattooing (medical micropigmentation). My provider, Kinesis Studio, is out-of-network. I will pay upfront and submit for reimbursement. Can you tell me how this is covered under my breast reconstruction benefits?”

Ask:

• Is nipple–areola tattooing covered as part of post-mastectomy reconstruction?

• What are my out-of-network benefits for this service?

• Do I need prior authorization or a referral?

• How do I submit a claim (portal, forms, mailing address)?

If they say it’s cosmetic, respond:

“This is part of my breast reconstruction after mastectomy. Under federal law, plans that cover mastectomy must cover all stages of reconstruction, including procedures that restore appearance and symmetry.”

Write down:

• Representative’s name

• Date and time of the call

• Reference number for the call (if given)

• Any instructions (authorizations, forms, deadlines)

Bring these notes to your appointment.

Step 3: Book Your Appointment & Pay Upfront

Once you understand your benefits, you’re ready to book your areola tattoo at Kinesis Studio.

At your visit:

• You’ll have your consultation and procedure

• You’ll pay the studio fee at the time of service (we do not bill insurance directly)

• You’ll have before/after photos, which can sometimes support your claim

From Kinesis Studio, you will receive:

• A detailed superbill / itemized receipt with:

  • Procedure description

  • Diagnosis and procedure codes we use for documentation

  • Amount paid

• A Letter of Medical Necessity template (if your doctor needs guidance)

• Brief procedure notes, if helpful

You can submit the claim yourself or use a third-party billing service if you prefer extra help.

Step 4: Submit Your Claim

After your appointment, submit your reimbursement packet to your insurance. Typically, this includes:

• Your Letter of Medical Necessity

• The itemized receipt / superbill from Kinesis Studio

• Any procedure notes we provide

• A copy of your insurance card (front and back), if requested

• Any claim form required for out-of-network services

Send via:

• Your insurer’s online member portal (preferred), or

• Mail/fax to the claims address on your insurance card

Typical processing time is 30–90 days. You will then receive an Explanation of Benefits (EOB) showing how the claim was handled and if reimbursement is due.

Step 5: If You’re Denied, Appeal

If your claim is denied, it does not mean the process is over.

1. Read your EOB and note the reason (cosmetic, out-of-network, missing prior authorization, etc.).

2. Prepare an appeal package, including:

   • An appeal letter stating this is reconstructive and part of post-mastectomy care

   • Your Letter of Medical Necessity

   • Your superbill/receipt and procedure notes

   • A copy of your EOB and your call notes

Ask your insurance about:

• A formal internal appeal

• Escalation to a supervisor or medical review

• If needed, how to request an external review

If you believe your reconstruction rights are not being honored, you may also contact your state insurance department for support and to file a complaint.

You Don’t Have to Navigate This Alone

Kinesis Studio will:

• Provide the documentation you need

• Help you understand which pieces to submit

• Encourage you to advocate for the coverage you’re entitled to as part of your reconstruction

You’ve already done so much hard work to get here. This final step is about helping you feel complete in your body—and it deserves to be taken seriously.