Size: px
Start display at page:

Download "info@asurgerycommitment.com"

Transcription

1 1

2 What is it? Remedial cover from the 29th day up to 24 months post surgery. Who is the insured person? You the surgeon are the insured person. How do I apply? You may apply online at The Costs Various levels of indemnity (claim amounts) are available as follows: Cover Band For Combined Procedures Costing up to: Level of Indemnity Total Premium Payable inc IPT* A 2,000 1, B 4,000 2, C 6,000 3, D 8,000 5, E 10,000 6, F 12,000 7, For higher levels of indemnity, relating to higher procedure costs, please contact us for a quote. Table 1 *The cost to You includes Insurance Premium Tax (IPT) 2

3 Procedures Covered Abdominoplasty Blepharoplasty Brachioplasty Breast Augmentation Buttock Implants Calf Augmentation Cheek Augmentation Chin Augmentation/Mentoplasty/Genioplasty Facelift Gluteoplasty Gynecomastia Liposuction Labiaplasty Mammoplasty/Mastopexy Male Pectoral Implants Otoplasty Rhinoplasty Thigh Lift Fat Grafting Diagnosed Conditions Abdominoplasty Wound Dehiscence, Infection, Necrosis of Umbilicus and Skin Loss of (more than 9cm sq.). Blepharoplasty Uppers : Excess Fat Removal, Incomplete Skin Removal, Infection Lowers : Ectropion, Entropion, Excess Fat Removal, Excess Skin Removal, Incomplete Fat Removal, Infection Brachioplasty Infection, Skin Necrosis (more than 9cm sq.), Wound Dehiscence. Breast Augmentation Infection, Necrosis (more than 9cm sq.), Malposition, Encapsulation (Baker Class III/IV), Extrusion of Implant, Seroma Buttock Implants Infection, Skin Necrosis (more than 9 cm sq.), Severe Asymmetry, Wound Dehiscence, Fat Necrosis Calf Augmentation Haematoma, Infection, Necrosis (more than 9cm sq.), Malposition, Encapsulation, Extrusion of Implant. Cheek Augmentation Necrosis (more than 9cm sq.), Malposition, Encapsulation, Extrusion of Implant, Nerve Injury,Infection Chin Augmentation/Mentoplasty/Genioplasty Infection, Necrosis (more than 9cm sq.), Malposition, Encapsulation, Extrusion of Implant, Nerve Injury, Infection, Chin Ptosis Facelift Late Sequelae of Haematoma, Infection, Wound Necrosis,Skin Necrosis, Nerve Injury, Seroma, Parotid Fistula, Ear Lobe Malposition, Hair Loss Fat Grafting Donor Site Dimpling, Necrosis at graft site, Infection, Excessive Fat Removal, Seroma, Skin Necrosis (more that 9cm sq.) at donor site 3

4 Gluteoplasty Infection, Necrosis (more than 9cm sq.), Severe Asymmetry, Wound Dehiscence, Fat Necrosis Gynecomastia Infection, Skin / Nipple Necrosis, Severe Asymmetry, Wound Dehiscence, Nipple Malposition, Fat Necrosis Liposuction Inadequate Fat Removal, Excessive Fat Removal, Redundant Skin, Infection, Seroma, Skin Necrosis (more than 9cm sq.) Labiaplasty Infection, Bleeding, Wound Dehiscence, Painful Scar, Significant Asymmetry Mammoplasty and Mastopexy Infection, Skin / Nipple Necrosis, Misshape, Severe Asymmetry, Dehiscence, Nipple Malposition, Fat Necrosis Male Pectoral Implants Infection, Skin / Nipple Necrosis, Malposition, Asymmetry, Encapsulation (Baker Class III/IV), Extrusion of Implant Otoplasty Cartilage Necrosis, Recurrence, Infection, Misshape and Significant Asymmetry Rhinoplasty Infection, Excess Bone/Cartilage Removal, Incomplete Infracture, Bulky Tip, Supra Tip Depression, Airway Obstruction, Valving Thigh Lift Infection, Skin Necrosis, Seroma, Scar Problems, Wound Dehiscence If however the procedure you wish to carry out is not on the list then you may enquire to ask if the procedure may be covered at info@asurgerycommitment.com. 4

5 Patient Information How do I let the patient know about the cover? At the consultation you may explain to your patient that as a BAAPS member you are part of the ASC and provide them with a copy of your personal A Surgery Commitment. Can I charge for the ASC? Yes, you can either absorb the costs into your fees or you may pass the costs onto the patient. It is important that you do not give the patient the impression they are purchasing insurance, instead they are paying for your commitment to cover the costs of remedial treatment in the unlikely event remedial treatment is necessary. What is the wording on the commitment to the patient? Your surgeon is covered by the Aesthetic Surgery Commitment. This is insurance that covers remedial treatment that may be necessary following your surgery. It covers the most common conditions that require revision surgery. In the unlikely event that your surgeon diagnoses you with one of these conditions, then the surgeon s insurance will cover the costs and charges for the corrective or remedial treatment to be carried out by your surgeon up to an agreed limit. This Commitment is valid for twenty four months from the date of your surgery. Your surgeon has only been accepted for ASC insurance because they are a BAAPS registered surgeon. For more information about this insurance, please visit You the surgeon, may choose to have a photograph and state how you would like your name and qualification printed on the commitment. 5

6 Declaring patients for Cover How do I notify the insurers of my patients on cover? This is done monthly in arrears and you will be contacted to ask how many patients you operated on in the previous month. A spreadsheet then needs to be completed which is one line per patient. A standard format will be supplied. What information do you need about my patients on cover? One line on the spreadsheet per patient with the following:- Patient ID Postcode Date of Birth Procedure Place of Surgery Surgeon Date of Procedure Indemnity Level of Cover Do I receive acknowledgement my patients are on cover? Once the spreadsheet has been received you will receive an acknowledgment. How do I pay the premiums? In arrears and when the spreadsheet has been submitted, an invoice will be sent to you with 14 days to pay the premiums due. Remedial Treatment What if my patient is unhappy with their procedure? ASC does not cover dissatisfaction due to the aesthetic look of the procedure. However, should your patient be dissatisfied due to a covered complication that you, their surgeon, has identified then the cost of the remedial treatment may be covered. Who decides if remedial treatment is necessary? The Surgeon always decides if a claim is to be submitted to the insurers. The insurers then make a decision to approve any remedial treatment based on the supporting documentation and photographs. 6

7 What if the patient/surgeon relationship has broken down? In the unlikely circumstances that the patient feels they are not able to return to their own surgeon they may and an adviser will call them to discuss their personal situation. Will another surgeon be recommended to my patient? Only with you the insured surgeon s permission would ASC provide the patient with another BAAPS surgeon for a further consultation. What happens after the consultation with the referred surgeon? A report will be provided to the original surgeon and only the original insured surgeon can approve for a claim to be submitted for remedial treatment. Claims How do I submit a claim? A claim must be submitted by or on behalf of the insured surgeon for their patient directly to ASC. By post or ? You may submit the claim by by attaching the relevant documents to claims@asurgerycommitment.com. If you are not able to the documents then you may post your claim documents to Sure Insurance Services, 42 Moorgate, London, EC2R 6EL. What information is needed to support the claim? A claim form needs to be completed and sent together with pre and post photographs together with any relevant patient notes. Is my claim acknowledged? Yes you will receive immediate confirmation by that your claim has been received. What happens to my claim after I have submitted it? The claim will be given to a claims handler to process and any further information will be requested. Should no further information be required it will be passed for approval. What happens if I proceed with revision surgery before my claim is approved? You should be aware that if you choose to go ahead with revision surgery before a relevant claim has been approved, then you may not be covered under the ASC insurance. 7

8 How do I know how much to claim for? When you insured the procedure you will have declared the cost of the original surgery and paid the premium accordingly for the level of indemnity as stated above. In the claim you must confirm costs for you the surgeon, hospital costs and aneathatist s fees. You will not be able to claim above the level of indemnity declared on the original declaration of cover. Who receives the settlement funds? You the surgeon, as the insured person, receives the settlement in respect of a successful claim. What if I have a high complication rate? Complication rates for each surgeon will be collected and monitored on a pro-rata monthly basis and where a surgeon s complication rate exceeds 5% in any one policy year, retraining and/or mentoring may be recommended, following a review from an independent panel. If you have any queries, please do not hesitate to contact our office at Sure Insurance Services Limited, 4th Floor, 42, Moorgate, London EC2R 6EL, Tel: +44 (0) , Fax +44 (0) , team@sureinsurance.co.uk. BAAPS Cosmetic Surgeons Insurance is administered by Sure Insurance Services Limited and is underwritten by certain Underwiters at Lloyd s. The underwriters and Sure Insurance Services Limited are authorised and regulated by the Financial Conduct Authority. You can check this information on the FCA s register by visiting the FCA s website 8

Quick Facts about Breast Augmentation with IDEAL IMPLANT Saline-filled Breast Implants

Quick Facts about Breast Augmentation with IDEAL IMPLANT Saline-filled Breast Implants Quick Facts about Breast Augmentation with IDEAL IMPLANT Saline-filled Breast Implants Important Factors Breast Augmentation Patients Should Consider October 2015 Caution: Federal law restricts this device

More information

Data from a total of 1,391 plastic surgeons were compiled for this survey.

Data from a total of 1,391 plastic surgeons were compiled for this survey. ISAPS International Survey on Aesthetic/Cosmetic Procedures Performed in 2014 Methodology: Survey participants completed a single-page questionnaire that focused on the number of specific surgical and

More information

Plastic Surgery. Statistics Report. ASPS National Clearinghouse of. Plastic Surgery. Procedural Statistics

Plastic Surgery. Statistics Report. ASPS National Clearinghouse of. Plastic Surgery. Procedural Statistics ASPS National Clearinghouse of Procedural Statistics All figures are projected. * Data unavailable in prior year. **77% of total breast implants were silicone; 23% were saline. ***Botulinum Toxin Type

More information

Plastic Surgery - Exceptional Referrals Patient Pathway April 2005

Plastic Surgery - Exceptional Referrals Patient Pathway April 2005 Patient Presentation Patient seeks exceptional procedure Clinical assessment: Psychology criteria (see Appendix 1) Exceptional physical criteria (see Appendix 2) Patient meets criteria Patient does not

More information

2013 Plastic Surgery Statistics Report

2013 Plastic Surgery Statistics Report All figures are projected. * Data unavailable in prior year. **72% of total breast implants were silicone; 28% were saline. ***Botulinum toxin type A numbers are of anatomic sites injected. ASPS National

More information

NORCOM COMMISSIONING POLICY. Specialist Plastic Surgery Procedures

NORCOM COMMISSIONING POLICY. Specialist Plastic Surgery Procedures NORCOM North Derbyshire, South Yorkshire and Bassetlaw Commissioning Consortium NORCOM COMMISSIONING POLICY Specialist Plastic Surgery Procedures January 2007 Review Date: January 2009 Prepared by Rotherham

More information

C A Stone (Medical & Legal) Ltd Breast Reduction Information Sheet. About Mr Stone

C A Stone (Medical & Legal) Ltd Breast Reduction Information Sheet. About Mr Stone Information for patients considering breast reduction and uplift surgery under the care of Mr C. Stone FRCS(Plast) Consultant Reconstructive & Aesthetic Plastic Surgeon About Mr Stone Mr Stone is a Consultant

More information

Sientra Silicone Gel Breast Implants Quick Facts About Breast Augmentation And Reconstruction

Sientra Silicone Gel Breast Implants Quick Facts About Breast Augmentation And Reconstruction Sientra Silicone Gel Breast Implants Quick Facts About Breast Augmentation And Reconstruction About This Brochure This brochure is intended to provide you with a high level overview of the facts about

More information

How To Improve Your Looks with Plastic Surgery

How To Improve Your Looks with Plastic Surgery How To Improve Your Looks with Plastic Surgery By Daniel Becker Plastic surgery is a special type of surgery that involves both a person's appearance and his or her ability to function. Plastic surgeons

More information

Life After Weight Loss Program Patient Guide

Life After Weight Loss Program Patient Guide Life After Weight Loss Program Patient Guide The new you. Weight loss either through bariatric surgery or diet and exercise is truly a life changing event. You look and feel better. You are healthier.

More information

Medical Necessity Guidelines: Reconstructive and Cosmetic Surgery

Medical Necessity Guidelines: Reconstructive and Cosmetic Surgery Medical Necessity Guidelines: Reconstructive and Cosmetic Surgery Effective: October 1, 2015 Clinical Documentation and Prior Authorization Required Coverage Guideline, No Prior Authorization Applies to:

More information

AUSTRALIAN SOCIETY OF PLASTIC SURGEONS MEDIA RESOURCE FOLDER

AUSTRALIAN SOCIETY OF PLASTIC SURGEONS MEDIA RESOURCE FOLDER AUSTRALIAN SOCIETY OF PLASTIC SURGEONS MEDIA RESOURCE FOLDER What is the Australian Society of Plastic Surgeons (ASPS)? Founded in 1970, the Australian Society of Plastic Surgeons Inc (ASPS) is the peak

More information

Patient information. Breast Asymmetry. Breast Services Directorate PIF 054 V5

Patient information. Breast Asymmetry. Breast Services Directorate PIF 054 V5 Patient information Breast Asymmetry Breast Services Directorate PIF 054 V5 Nobody has breasts that are exactly the same size. However, if this is very noticeable, surgery is often helpful. It is usually

More information

In terms of cup size, how much of an enlargement would you like to achieve?

In terms of cup size, how much of an enlargement would you like to achieve? Information for patients considering breast augmentation surgery under the care of Mr C. Stone FRCS(Plast) Consultant Reconstructive & Aesthetic Plastic Surgeon About Mr Stone Mr Stone is a Consultant

More information

INFORMATION ON COSMETIC AND RECONSTRUCTIVE SURGERY(S) SUR716.001

INFORMATION ON COSMETIC AND RECONSTRUCTIVE SURGERY(S) SUR716.001 INFORMATION ON COSMETIC AND RECONSTRUCTIVE SURGERY(S) SUR716.001 NOTE: The members contract should be reviewed. Contract language may vary regarding the definition of reconstructive services for different

More information

Structual Fat Transfer (Fat Injection to the Breast) Musgrove Park Hospital is part of Taunton and Somerset NHS Foundation Trust. Patient Information

Structual Fat Transfer (Fat Injection to the Breast) Musgrove Park Hospital is part of Taunton and Somerset NHS Foundation Trust. Patient Information Structual Fat Transfer (Fat Injection to the Breast) Musgrove Park Hospital is part of Taunton and Somerset NHS Foundation Trust Patient Information Introduction This information is for patients undergoing

More information

Breast Implants: Local Complications and Adverse Outcomes

Breast Implants: Local Complications and Adverse Outcomes Breast Implants: Local Complications and Adverse Outcomes This booklet highlights the most common problems associated with silicone gel-filled and saline-filled breast implants: those that occur in the

More information

body breast augmentation

body breast augmentation face body skin breast augmentation Rowena After years of self confidence issues and feeling out of proportion to the rest of my body, I felt I needed to make a change for me! breast augmentation considering

More information

Name of Policy: Reconstructive versus Cosmetic Surgery

Name of Policy: Reconstructive versus Cosmetic Surgery Name of Policy: Reconstructive versus Cosmetic Surgery Policy #: 106 Latest Review Date: February 2010 Category: Administrative Policy Grade: Background/Definitions: As a general rule, benefits are payable

More information

Breast Reconstruction Options. Department of Plastic Surgery #290 Santa Clara Homestead Campus

Breast Reconstruction Options. Department of Plastic Surgery #290 Santa Clara Homestead Campus Breast Reconstruction Options Department of Plastic Surgery #290 Santa Clara Homestead Campus Importance of Breast Reconstruction As successes in treating breast cancer have grown, more women have been

More information

Cosmetic Surgery Procedures

Cosmetic Surgery Procedures Last Review Date: July 20, 2015 Number: MG.MM.AD.07cC2 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth

More information

INSTITUTE OF COSMETIC & LASER SURGERY TREATMENTS

INSTITUTE OF COSMETIC & LASER SURGERY TREATMENTS Acne Blu-U (with or without Levulan ) Chemical Peels Microdermabrasion Smoothbeam Physician grade products Prescription Acne Scarring CO2 Laser E2 Erbium Laser Fraxel Laser Juvéderm Microdermabrasion Pixel

More information

Survey participants completed a two-page questionnaire that focused on the number of surgical and non-surgical procedures they performed in 2013.

Survey participants completed a two-page questionnaire that focused on the number of surgical and non-surgical procedures they performed in 2013. ISAPS International Survey on Aesthetic/Cosmetic Procedures Performed in 2013 Methodology: Survey participants completed a two-page questionnaire that focused on the number of surgical and non-surgical

More information

Stephen Evangelisti, M.D. Excellence in Plastic Surgery: A Unique Approach

Stephen Evangelisti, M.D. Excellence in Plastic Surgery: A Unique Approach Western NY/Rochester Edition Stephen Evangelisti, M.D. Excellence in Plastic Surgery: A Unique Approach cover story Stephen Evangelisti, M.D. Excellence in Plastic Surgery: A Unique Approach By Julie Nusbaum

More information

Body Jet - Water Assisted Liposuction

Body Jet - Water Assisted Liposuction Steven L. Ringler, MD, FACS Introducing: SmartLipo Triplex Laser-BodySculpting Body Jet - Water Assisted Liposuction CoolSculpting by Zeltiq *Experience Exceptional - Dr. Steven L. Ringler and The Center

More information

PANNICULECTOMY & BODY CONTOURING PROCEDURES

PANNICULECTOMY & BODY CONTOURING PROCEDURES COVERAGE DETERMINATION GUIDELINE PANNICULECTOMY & BODY CONTOURING PROCEDURES Guideline Number: CDG.014.05 Effective Date: December 1, 2015 Table of Contents COVERAGE RATIONALE... DEFINITIONS. APPLICABLE

More information

INFORMED CONSENT FOR BODY CONTOURING PLEASE REVIEW AND BRING WITH YOU ON THE DAY OF YOUR PROCEDURE

INFORMED CONSENT FOR BODY CONTOURING PLEASE REVIEW AND BRING WITH YOU ON THE DAY OF YOUR PROCEDURE INFORMED CONSENT FOR BODY CONTOURING (INCLUDES: LIPOSUCTION, ABDOMINOPLASTY, ARMLIFT, THIGHLIFT AND BODYLIFT) PLEASE REVIEW AND BRING WITH YOU ON THE DAY OF YOUR PROCEDURE PATIENT NAME PATIENT INITIALS

More information

Motiva Implant Matrix Silicone Breast Implants Summary of Clinical Data 4-Year Follow Up

Motiva Implant Matrix Silicone Breast Implants Summary of Clinical Data 4-Year Follow Up Motiva Implant Matrix Silicone Breast Implants Summary of Clinical Data 4-Year Follow Up October 2010 - March 2015 Motiva Implant Matrix Silicone Breast Implants Prospective Clinical Evaluation: 4-Year

More information

APPENDIX D. April 1, 2015 AD1 Amd 12 Draft 1. Appendix DApril 1, 2015 PREAMBLE

APPENDIX D. April 1, 2015 AD1 Amd 12 Draft 1. Appendix DApril 1, 2015 PREAMBLE Appendix DApril 1, 2015 PREAMBLE 1. Surgery to alleviate significant physical symptoms, which have not responded to a minimum of six months active treatment, or to restore or improve function to any area

More information

Breast Augmentation Amsterdam Plastic Surgery Breast Augmentation Overview

Breast Augmentation Amsterdam Plastic Surgery Breast Augmentation Overview Breast Augmentation Amsterdam Plastic Surgery Breast Augmentation Overview The long-lasting results of breast augmentation are not limited to just physical changes as data documents that many patients

More information

Breast reduction surgery

Breast reduction surgery Pan Manchester Patient Information Service July 2007 Plastic Surgery Department Issue 2 BSBR Pan Manchester Plastic Surgery Services Department of Plastic Surgery Acknowledgement: Written by Mr P Kumar,

More information

NEW JERSEY STATE BOARD OF MEDICAL EXAMINERS Application for Privileges N.J.A.C. 13:35-4A.12 PLASTIC AND RECONSTRUCTIVE SURGERY

NEW JERSEY STATE BOARD OF MEDICAL EXAMINERS Application for Privileges N.J.A.C. 13:35-4A.12 PLASTIC AND RECONSTRUCTIVE SURGERY NEW JERSEY STATE BOARD OF MEDICAL EXAMINERS Application for Privileges N.J.A.C. 13:35-4A.12 PLASTIC AND RECONSTRUCTIVE SURGERY Plastic Surgery Procedures: PRIVILEGE CRITERIA 1. Attestation (Attachment

More information

Lipomodelling Following Breast Surgery

Lipomodelling Following Breast Surgery Lipomodelling Following Breast Surgery Patient Information Breast Care Department Author ID: SW/AD/EA Leaflet Number: SBC 010 Name of Leaflet: Lipomodelling Following Breast Surgery Date Produced: October

More information

GUIDELINES ON AESTHETIC FACIAL PROCEDURES FOR DENTAL PRACTITIONERS

GUIDELINES ON AESTHETIC FACIAL PROCEDURES FOR DENTAL PRACTITIONERS GUIDELINES ON AESTHETIC FACIAL PROCEDURES FOR DENTAL PRACTITIONERS INTRODUCTION 1. This document serves as a guideline on aesthetic facial procedures for dental practitioners. It does not include aesthetic

More information

Cosmetic Surgery Center

Cosmetic Surgery Center Introduction Cosmetic Surgery Center The cosmetic surgery center started in1997, located at 11th floor of the children hospital of CMU. Our center is aimed at engaging the four characteristics of Professionalism,

More information

ABDOMINOPLASTY - FREQUENTLY ASKED QUESTIONS (FAQs)

ABDOMINOPLASTY - FREQUENTLY ASKED QUESTIONS (FAQs) Executive Level E1, Excen Centre, 119 Willoughby Road, Crows Nest 2065 Tel: 02 9817 7585 www.mycosmeticclinic.net AFFORDABILITY WITH EXCELLENCE Liposuction Breast Augmentation Abdominoplasty Eyelids Surgery

More information

How To Learn About Breast Augmentation

How To Learn About Breast Augmentation HOB ANNUAL ASAPS Conference H O B A R T, T A S M A N I A Hotel Grand Chancellor, 29 July - 3 August 2014 HOB ANNUAL ASAPS Conference H O B A R T, T A S M A N I A Hotel Grand Chancellor, 29 July - 3 August

More information

CONSENT FOR BREAST IMPLANT REMOVAL

CONSENT FOR BREAST IMPLANT REMOVAL CONSENT FOR BREAST IMPLANT REMOVAL GENERAL INFORMATION The removal of breast implants that have been placed either for cosmetic or reconstructive purposes is a surgical operation. Breast implant removal

More information

Dentistry. Specialty Report. Group. MedPro Group Patient Safety & Risk Solutions. Berkshire Hathaway's dedicated healthcare liability solution

Dentistry. Specialty Report. Group. MedPro Group Patient Safety & Risk Solutions. Berkshire Hathaway's dedicated healthcare liability solution Dentistry Specialty Report April 2015 MedPro Group Patient Safety & Risk Solutions Group Berkshire Hathaway's dedicated healthcare liability solution MedPro Group is a member of the Berkshire Hathaway

More information

Information for Commissioners of Plastic Surgery Services. Referrals and Guidelines in Plastic Surgery

Information for Commissioners of Plastic Surgery Services. Referrals and Guidelines in Plastic Surgery Information for Commissioners of Plastic Surgery Services Referrals and Guidelines in Plastic Surgery Introduction Whilst most of the work of plastic surgeons in the NHS concerns the restoration of appearance

More information

Breast Surgery Criteria Based Access Protocol Supporting people in Dorset to lead healthier lives

Breast Surgery Criteria Based Access Protocol Supporting people in Dorset to lead healthier lives NHS Dorset Clinical Commissioning Group Breast Surgery Criteria Based Access Protocol Supporting people in Dorset to lead healthier lives POLICY TRAIL AND VERSION CONTROL SHEET: Protocol Reference: Version:

More information

Bariatric Surgery. Plastic Surgery. In Vitro Fertilization. SPA and Wellness. Dental Aesthetic. all inclusive holidays

Bariatric Surgery. Plastic Surgery. In Vitro Fertilization. SPA and Wellness. Dental Aesthetic. all inclusive holidays SPA and Wellness inbound medical tourism in the CZECH REPUBLIC Bariatric Surgery Plastic Surgery In Vitro Fertilization all inclusive holidays Dental Aesthetic affordable prices luxurious treatment packages

More information

It is important that you read this information carefully and completely.

It is important that you read this information carefully and completely. Placement of Permanent Breast Implant Following Tissue Expansion 1. I hereby authorize Dr. John P. Stratis and such assistants as may be selected to perform the following procedure or treatment INFORMED-

More information

WEIGHT LOSS. ThePlasticDoc.com

WEIGHT LOSS. ThePlasticDoc.com WEIGHT LOSS ThePlasticDoc.com The brochure you have been provided contains nudity. If you are offended by such material or are not at least 18 years of age, please do not read further. WEIGHT LOSS SURGERY

More information

Accident And/Or Sickness Claim Form

Accident And/Or Sickness Claim Form Accident And/Or Sickness Claim Form Please forward this completed form to: Claims Department JUA Underwriting Agency Pty Ltd Locked Bag 11 ROYAL EXCHANGE POST OFFICE NSW 1225 Policy underwritten by certain

More information

FAQ s COSMETIC SURGERY

FAQ s COSMETIC SURGERY 290 Country Club Drive, Stockbridge, Georgia 30281 770.506.9123 www.schillingmedicalspa.com FAQ s COSMETIC SURGERY Smartlipo HOW DOES SMARTLIPO WORK? This laser-assisted lipolysis procedure is performed

More information

XXXXX File No. 108655-001 Petitioner v. Issued and entered this 28 th day of June 2010 by Ken Ross Commissioner ORDER I PROCEDURAL BACKGROUND

XXXXX File No. 108655-001 Petitioner v. Issued and entered this 28 th day of June 2010 by Ken Ross Commissioner ORDER I PROCEDURAL BACKGROUND STATE OF MICHIGAN DEPARTMENT OF ENERGY, LABOR & ECONOMIC GROWTH OFFICE OF FINANCIAL AND INSURANCE REGULATION Before the Commissioner of Financial and Insurance Regulation In the matter of XXXXX File No.

More information

Income Protection Insurance

Income Protection Insurance Income Protection Insurance Policy Summary Key Information You the Customer Need To Be Aware Of Please read this document carefully. This policy summary does not contain the full terms, exclusions and

More information

Queensland. Health Legislation (Restriction on Use of Cosmetic Surgery for Children and Another Measure) Amendment Bill 2008

Queensland. Health Legislation (Restriction on Use of Cosmetic Surgery for Children and Another Measure) Amendment Bill 2008 Queensland Health Legislation (Restriction on Use of Cosmetic Surgery for Children and Another Measure) Amendment Bill 00 Queensland Health Legislation (Restriction on Use of Cosmetic Surgery for Children

More information

Basal Cell Carcinoma Affecting the Eye Your Treatment Explained

Basal Cell Carcinoma Affecting the Eye Your Treatment Explained Basal Cell Carcinoma Affecting the Eye Your Treatment Explained Patient Information Introduction This booklet is designed to give you information about having a Basal Cell Carcinoma near your eye and the

More information

INFORMED CONSENT LIPOSUCTION (Suction-Assisted Lipectomy Surgery) (Ultrasound-Assisted Lipectomy Surgery)

INFORMED CONSENT LIPOSUCTION (Suction-Assisted Lipectomy Surgery) (Ultrasound-Assisted Lipectomy Surgery) . Purchasers of the Patient Consultation Resource Book are given a limited license to modify documents contained herein and reproduce the modified version for use in the Purchaser's own practice only.

More information

Clinic for Plastic Surgery and Aesthetic Medicine. Registration Monday - Friday from 11:00 to 19:00

Clinic for Plastic Surgery and Aesthetic Medicine. Registration Monday - Friday from 11:00 to 19:00 Clinic for Plastic Surgery and Aesthetic Medicine ul. Róży Wiatrów 10, 53-023 Wrocław tel. 0048 71 790 50 50, 0048 600 100 183 info@klinikawiatroszak.pl www.klinikawiatroszak.pl Registration Monday - Friday

More information

UNMH Oral and Maxillofacial Surgery Clinical Privileges

UNMH Oral and Maxillofacial Surgery Clinical Privileges All new applicants must meet the following requirements as approved by the UNMH Board of Trustees effective: 09/26/2014 INSTRUCTIONS Applicant: Check off the "Requested" box for each privilege requested.

More information

Pre-Visit Questionnaire: Out-of-Hospital Premises Inspection Program

Pre-Visit Questionnaire: Out-of-Hospital Premises Inspection Program Submission Checklist Please ensure you include the following documentation in your completed submission: Completed Pre-Visit Questionnaire Submission Checklist Completed and signed Pre-Visit Questionnaire

More information

INCOME PROTECTION INSURANCE Introduced by British Insurance. Policy Summary Key Information You the Customer Need To Be Aware Of

INCOME PROTECTION INSURANCE Introduced by British Insurance. Policy Summary Key Information You the Customer Need To Be Aware Of Introduced by British Insurance Policy Summary Key Information You the Customer Need To Be Aware Of Please read this document carefully. This policy summary does not contain the full terms exclusions and

More information

Patient Educational Brochure AUGMENTATION. Breast Augmentation with MENTOR MemoryGel Silicone Gel Breast Implants

Patient Educational Brochure AUGMENTATION. Breast Augmentation with MENTOR MemoryGel Silicone Gel Breast Implants Patient Educational Brochure AUGMENTATION Breast Augmentation with MENTOR MemoryGel Silicone Gel Breast Implants 1 PATIENT EDUCATIONAL BROCHURE AUGMENTATION BREAST AUGMENTATION WITH MENTOR MEMORYGEL SILICONE

More information

Eurosilicone. Options for Breast Augmentation

Eurosilicone. Options for Breast Augmentation Eurosilicone Options for Breast Augmentation Introduction Along with the trend towards the increasing importance of the way you look and because of changes in lifestyle, more and more women are concerned

More information

NATRELLE 410 Highly Cohesive

NATRELLE 410 Highly Cohesive Breast Augmentation NATRELLE 410 Highly Cohesive Anatomically Shaped Silicone-Filled Breast Implants Important Factors Breast Augmentation Patients Should Consider Highly Cohesive Anatomically Shaped Silicone-Filled

More information

INFORMED CONSENT BREAST LIFT (MASTOPEXY)

INFORMED CONSENT BREAST LIFT (MASTOPEXY) Purchasers of the Patient Consultation Resource Book are given a limited license to modify documents contained herein and reproduce the modified version for use in the Purchaser's own practice only. All

More information

R&Q Commercial Risk Services Limited Liability Combined Insurance Summary of Cover

R&Q Commercial Risk Services Limited Liability Combined Insurance Summary of Cover R&Q Commercial Risk Services Limited Liability Combined Insurance Summary of Cover March 2014 Edition Contractors All Risks and Liability Combined Insurance Policy Overview About R&Q This Insurance product

More information

PG Mutual Medical Care Plan

PG Mutual Medical Care Plan It didn t take Jeff long to get back to everyday life following his operation. Thank goodness for PG Mutual s private medical insurance PG Mutual Medical Care Plan PG Mutual Medical Starter Plan Why you

More information

Michael A. Boss, M.D. FMH Plastic, Reconstructive und Aesthetic Surgery

Michael A. Boss, M.D. FMH Plastic, Reconstructive und Aesthetic Surgery Michael A. Boss, M.D. FMH Plastic, Reconstructive und Aesthetic Surgery Boss Aesthetic Center Schauplatzgasse 23 CH-3011 Bern Switzerland +41 31 311 7691 www.aesthetic-center.com B r e a s t A u g m e

More information

Mansfield*Cosmetic*Surgery*Center* *New*Patient*Welcome*Packet* 817>477>9000* *www.mansfieldcosmeticsurgery.com*

Mansfield*Cosmetic*Surgery*Center* *New*Patient*Welcome*Packet* 817>477>9000* *www.mansfieldcosmeticsurgery.com* DearPatient, WelcometoMansfieldCosmeticSurgeryCenter,thecosmeticsurgerypracticeofDr. MichaelL.Thornton,afellowship>trainedcosmeticsurgeonandDiplomateoftheAmerican BoardofCosmeticSurgery. ThisNew$Patient$Welcome$Packetwillspecificallyprovidevaluableinformationaboutthe

More information

Breast Augmentation. If you are dissatisfied with your breast size, augmentation surgery is a choice to consider. Breast augmentation can:

Breast Augmentation. If you are dissatisfied with your breast size, augmentation surgery is a choice to consider. Breast augmentation can: Breast Augmentation What is Breast Augmentation? Also known as augmentation mammaplasty, breast augmentation involves using implants to fulfill your desire for fuller breasts or to restore breast volume

More information

R&Q Commercial Risk Services Limited Contractors All Risks and Liability Combined Insurance Summary of Cover

R&Q Commercial Risk Services Limited Contractors All Risks and Liability Combined Insurance Summary of Cover R&Q Commercial Risk Services Limited Contractors All Risks and Liability Combined Insurance Summary of Cover June 2012 Edition Contractors All Risks and Liability Combined Insurance Policy Overview About

More information

SPECIALISED SERVICES POLICY: CP69 BREAST SURGERY PROCEDURES

SPECIALISED SERVICES POLICY: CP69 BREAST SURGERY PROCEDURES SPECIALISED SERVICES POLICY: CP69 BREAST SURGERY PROCEDURES Document Author: Specialised Planner Executive Lead: Director of Planning Approved by: WHSSC Joint Committee Issue Date: 16 July 2013 Review

More information

Sports Injury CLAIM FORM. Call ATC Claims for assistance on 1800 994 694. 1. You complete Section A and B.

Sports Injury CLAIM FORM. Call ATC Claims for assistance on 1800 994 694. 1. You complete Section A and B. INSURANCE SOLUTIONS CLAIM FORM Sports Injury EXTF04820140311 Call ATC Claims for assistance on 1800 994 694 1. You complete Section A and B. 2. If you have a Non Medicare Expense claim, you should also

More information

To our knowledge, a long-term follow-up study COSMETIC

To our knowledge, a long-term follow-up study COSMETIC COSMETIC Outcomes Article The Measure of Face-Lift Patient Satisfaction: The Owsley Facelift Satisfaction Survey with a Long-Term Follow-Up Study Michael T. Friel, M.D. Richard E. Shaw, Ph.D. Matthew J.

More information

Sports Health Insurance. application form for clubs with 10 members or more

Sports Health Insurance. application form for clubs with 10 members or more Sports Health Insurance application form for clubs with 10 members or more Here to Help We hope you will find this application form easy and straightforward to complete but if you require any assistance

More information

Dr. CENK TOKAT 1 / 8 PLASTIC RECONSTRUCTIVE AESTHETIC SURGEON

Dr. CENK TOKAT 1 / 8 PLASTIC RECONSTRUCTIVE AESTHETIC SURGEON 1 / 8 Dr. CENK TOKAT PLASTIC RECONSTRUCTIVE AESTHETIC SURGEON BUTTOCK AUGMENTATION (FAT TRANSFER) SURGICAL CONSENT FORM PATIENT S NAME & SURNAME: OPERATION DATE: This consent form is signed between DR

More information

SUBJECT: MANAGEMENT OF BREAST EFFECTIVE DATE: 12/16/99 IMPLANTS REVISED DATE:

SUBJECT: MANAGEMENT OF BREAST EFFECTIVE DATE: 12/16/99 IMPLANTS REVISED DATE: MEDICAL POLICY SUBJECT: MANAGEMENT OF BREAST PAGE: 1 OF: 5 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical policy

More information

INFORMATION SHEET FAT TRANSFER

INFORMATION SHEET FAT TRANSFER INFORMATION SHEET FAT TRANSFER INTRODUCTION In the past surgeons have tried to enlarge women s breasts and to fill out contour hollows by cutting out a lump of fat from the abdomen or buttocks and embedding

More information

This is my information booklet: Introduction

This is my information booklet: Introduction Hip arthroscopy is a relatively new procedure which allows the surgeon to diagnose and treat hip disorders by providing a clear view of the inside of the hip with very small incisions. This is a more complicated

More information

Regions Hospital Delineation of Privileges Oral & Maxillofacial Surgery

Regions Hospital Delineation of Privileges Oral & Maxillofacial Surgery Regions Hospital Delineation of Privileges al & Maxillofacial Surgery Applicant s Name: Last First M. Instructions: Place a check-mark where indicated for each core group you are requesting. Review education

More information

Recurrent Varicose Veins

Recurrent Varicose Veins Information for patients Recurrent Varicose Veins Sheffield Vascular Institute Northern General Hospital You have been diagnosed as having Varicose Veins that have recurred (come back). This leaflet explains

More information

Dance Teachers Insurance

Dance Teachers Insurance Dance Teachers Insurance Policy information and proposal form Royal Academy of Dance Insurance scheme available to members and authorised personnel based in the UK Policy information As a member or authorised

More information

Medical Recovery Insurance Company Guide. Let MyRecoveryCheque TM ease the financial pain of a hospital stay. www.myrecoverycheque.co.

Medical Recovery Insurance Company Guide. Let MyRecoveryCheque TM ease the financial pain of a hospital stay. www.myrecoverycheque.co. Medical Recovery Insurance Company Guide Let MyRecoveryCheque TM ease the financial pain of a hospital stay www.myrecoverycheque.co.uk Introducing MyRecoveryCheque TM Many employees today are concerned

More information

Breast Augmentation Information Sheet

Breast Augmentation Information Sheet Breast Augmentation Information Sheet Are you thinking about Breast Augmentation? If you are considering surgery, Dr. Peterson wants you to be thoroughly informed about this procedure. Reading this brochure

More information

Clinical Privileges Profile Plastic Surgery. Indu & Raj Soin Medical Center

Clinical Privileges Profile Plastic Surgery. Indu & Raj Soin Medical Center Printed Name Clinical Privileges Profile Plastic Surgery Indu & Raj Soin Medical Center Applicant: Check off the Requested box for each privilege requested. Applicants have the burden of producing information

More information

Kiss the Dust - Download Read PDF EPUB

Kiss the Dust - Download Read PDF EPUB Kiss the Dust - Download Read PDF EPUB Because the Iraqi secret police are looking for her father, Tara Hawrami and her family must flee the only home they have ever known and live in a brutal refugee

More information

PERSONAL INJURY CLAIM FORM

PERSONAL INJURY CLAIM FORM Office use only Policy NO: CANO01SII-0613 Claim Number: PERSONAL INJURY CLAIM FORM INSURANCE BROKER FOR : V-Insurance Group Pty Ltd Authorised Representative No. 432898 an authorised representative of

More information

Innovations in Aesthetic Surgery: A Multidisciplinary Symposium

Innovations in Aesthetic Surgery: A Multidisciplinary Symposium Florida 14th Annual Innovations in Aesthetic Surgery: A Multidisciplinary Symposium March 22 24, 2013 Eden Roc Renaissance Miami Beach Miami Beach, FL NEW LOCATION MIAMI BEACH! Endorsed by: The American

More information

Employers' Liability Insurance Insurance Summary

Employers' Liability Insurance Insurance Summary Employers' Liability Insurance Underwritten by a member of the QBE Insurance Group (QBE) This insurance is an annual contract unless stated otherwise in the quotation or renewal documentation and as confirmed

More information

Sports Health Insurance. application form for clubs with 20 members or more

Sports Health Insurance. application form for clubs with 20 members or more Sports Health Insurance application form for clubs with 20 members or more Here to Help We hope you will find this application form easy and straightforward to complete but if you require any assistance

More information

Knee arthroscopy advice sheet

Knee arthroscopy advice sheet Knee arthroscopy advice sheet During an arthroscopy, a camera is inserted into the knee through two or three small puncture wounds. It allows the surgeon to look at the joint surfaces, cartilage and the

More information

FRANK AGULLO, MD, FACS

FRANK AGULLO, MD, FACS FRANK AGULLO, MD, FACS SOUTHWEST PLASTIC SURGERY 10175 GATEWAY BLVD W #210, EL PASO, TX 79925 (915) 590-7900 EDUCATION 2007 2009 Plastic Surgery Mayo Clinic Rochester, Minnesota 2002 2007 General Surgery

More information

Non-Negligence Liability Insurance (UK) Insurance Summary

Non-Negligence Liability Insurance (UK) Insurance Summary Non-Negligence Liability Insurance (UK) Non-Negligence Liability Insurance (UK) is underwritten by a member of the QBE Insurance Group (QBE) This insurance is a non-renewable insurance contract and the

More information

BREAST RECONSTRUCTION POST MASTECTOMY

BREAST RECONSTRUCTION POST MASTECTOMY BREAST RECONSTRUCTION POST MASTECTOMY CLINICAL POLICY Policy Number: SURGERY 095.11 T2 Effective Date: January 1, 2016 Table of Contents CONDITIONS OF COVERAGE... BENEFIT CONSIDERATIONS... COVERAGE RATIONALE...

More information

Blepharoplasty & Cosmetic eyelid surgery

Blepharoplasty & Cosmetic eyelid surgery Our cosmetic surgery team at The USF Eye Institute offers a wide variety of cosmetic procedures of the eyelids and face with the goal of obtaining a natural and rejuvenated appearance. Dr.Leyngold has

More information

Important Information for Reconstruction Patients about Mentor MemoryGel Silicone Gel-Filled Breast Implants

Important Information for Reconstruction Patients about Mentor MemoryGel Silicone Gel-Filled Breast Implants Important Information for Reconstruction Patients about Mentor MemoryGel Silicone Gel-Filled Breast Implants 1 Important Information for Reconstruction Patients about Mentor MemoryGel Silicone Gel-Filled

More information

Oncoplastic breast surgery e A guide to good practice

Oncoplastic breast surgery e A guide to good practice EJSO 33 (2007) S1eS23 www.ejso.com Oncoplastic breast surgery e A guide to good practice On behalf of the Association of Breast Surgery at BASO, BAPRAS and the Training Interface Group in Breast Surgery*

More information

Plastic Surgery After Rapid Weight Loss

Plastic Surgery After Rapid Weight Loss PRINTER-FRIENDLY VERSION AT GENERALSURGERYNEWS.COM Plastic Surgery After Rapid Weight Loss J. BRIAN BOYD, MD, FRCS, FRCSC, FACS Professor of Surgery, David Geffen School of Medicine at UCLA Chief of Plastic

More information

PG Mutual Medical Care Plan

PG Mutual Medical Care Plan It didn t take Jeff long to get back to everyday life following his operation. Thank goodness for PG Mutual s private medical insurance PG Mutual Medical Care Plan Why you need private medical cover The

More information

Designer Laser Vaginoplasty (Autologous Fat Transplant to the Labia Majora) RISK AND COMPLICATIONS

Designer Laser Vaginoplasty (Autologous Fat Transplant to the Labia Majora) RISK AND COMPLICATIONS Designer Laser Vaginoplasty (Autologous Fat Transplant to the Labia Majora) List of possible complications: Hemorrhage Infection Hematoma: Collection of blood in tissues. Hyposesation Hypersensation Varied

More information

Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website.

Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Local Coverage Determination (LCD): Plastic Surgery (L35163) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Contractor Information Contractor Name

More information

INFORMED-CONSENT BREAST AUGMENTATION

INFORMED-CONSENT BREAST AUGMENTATION RICHARD A. BARTLETT, M.D. Board Certified-American Board of Plastic Surgery Member-American Society of Plastic Surgeons Member-American Society for Aesthetic Plastic Surgery INFORMED-CONSENT BREAST AUGMENTATION

More information

A separate consent form for the use of breast implants in conjunction with mastopexy is necessary.

A separate consent form for the use of breast implants in conjunction with mastopexy is necessary. INFORMED CONSENT BREAST LIFT (MASTOPEXY) INSTRUCTIONS This is an informed consent document that has been prepared to help your plastic surgeon inform you about mastopexy surgery, its risks, and alternative

More information

Dr. Justin B. Maxhimer, M.D. Boulder Plastic Surgery: 303-443-2277. IV Seasons Skin Care: 303-938-1666 www.boulderplasticsurgery.

Dr. Justin B. Maxhimer, M.D. Boulder Plastic Surgery: 303-443-2277. IV Seasons Skin Care: 303-938-1666 www.boulderplasticsurgery. Dr. Hans R. Kuisle, M.D., F.A.C.S Dr. Winfield Hartley, M.D., F.A.C.S Dr. Justin B. Maxhimer, M.D. 2525 4 th Street, Suite 200, Boulder, CO 80304 Boulder Plastic Surgery: 303-443-2277 IV Seasons Skin Care:

More information

Corporate Medical Policy Reconstructive Eyelid Surgery and Brow Lift

Corporate Medical Policy Reconstructive Eyelid Surgery and Brow Lift Corporate Medical Policy Reconstructive Eyelid Surgery and Brow Lift File Name: Origination: Last CAP Review: Next CAP Review: Last Review: reconstructive_eyelid_surgery_and_brow_lift 1/2000 9/2015 9/2016

More information